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Olivella A, Almenar-Bonet L, Moliner P, Coloma E, Martínez-Rubio A, Paz Bermejo M, Boixeda R, Cediel G, Méndez Fernández AB, Facila Rubio L. Role of vericiguat in management of patients with heart failure with reduced ejection fraction after worsening episode. ESC Heart Fail 2024; 11:628-636. [PMID: 38158630 DOI: 10.1002/ehf2.14647] [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: 02/03/2023] [Revised: 10/26/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024] Open
Abstract
Worsening heart failure (HF) is a vulnerable period in which the patient has a markedly high risk of death or HF hospitalization (up to 10% and 30%, respectively, within the first weeks after episode). The prognosis of HF patients can be improved through a comprehensive approach that considers the different neurohormonal systems, with the early introduction and optimization of the quadruple therapy with sacubitril-valsartan, beta-blockers, mineralocorticoid receptor antagonists, and inhibitors. Despite that, there is a residual risk that is not targeted with these therapies. Currently, it is recognized that the cyclic guanosine monophosphate deficiency has a negative direct impact on the pathogenesis of HF, and vericiguat, an oral stimulator of soluble guanylate cyclase, can restore this pathway. The effect of vericiguat has been explored in the VICTORIA study, the largest chronic HF clinical trial that has mainly focused on patients with recent worsening HF, evidencing a significant 10% risk reduction of the primary composite endpoint of cardiovascular death or HF hospitalization (number needed to treat 24), after adding vericiguat to standard therapy. This benefit was independent of background HF therapy. Therefore, optimization of treatment should be performed as earlier as possible, particularly within vulnerable periods, considering also the use of vericiguat.
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Affiliation(s)
- Aleix Olivella
- Heart Failure Unit, Department of Cardiology, Hospital Universitari Vall d'Hebrón, Vall d'Hebrón Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Almenar-Bonet
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Heart Failure and Transplantation Unit, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Pedro Moliner
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Community Heart Failure Program (UMICO), Department of Cardiology, Bellvitge University Hospital, Barcelona, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Emmanuel Coloma
- Heart Failure and Transplantation Unit, Internal Medicine Department and Hospital at Home Unit, Hospital Clinic, Barcelona, Spain
- Instituto de Investigaciones Médicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Antoni Martínez-Rubio
- Department of Cardiology, Hospital Universitario de Sabadell, Sabadell, Spain
- Universidad Autonoma de Barcelona, Sabadell, Spain
| | | | - Ramon Boixeda
- Department of Internal Medicine, Hospital de Mataró, Mataró, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - German Cediel
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Heart Failure Unit, Department of Cardiology, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Ana Belén Méndez Fernández
- Heart Failure Unit, Department of Cardiology, Hospital Universitari Vall d'Hebrón, Vall d'Hebrón Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lorenzo Facila Rubio
- Department of Cardiology, Hospital General de Valencia, Universitat de Valencia, Avda. Tres Cruces 2, 46014, Valencia, Spain
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Morillas H, Núñez J, Moliner P. Circulating levels of carbohydrate antigen 125 in chronic heart failure: Useful or futile? Eur J Heart Fail 2024. [PMID: 38562007 DOI: 10.1002/ejhf.3212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Herminio Morillas
- Community Heart Failure Unit, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Pedro Moliner
- Community Heart Failure Unit, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L'Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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3
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Pons-Riverola A, Morillas H, Berdejo J, Pernas S, Pomares H, Asiain L, Garay A, Fernandez-Ortega A, Oliveira AC, Martínez E, Jiménez-Marrero S, Pina E, Fort E, Ramos R, Alcoberro L, Hidalgo E, Antonio-Rebollo M, Alcober L, Enjuanes Grau C, Comín-Colet J, Moliner P. Developing Cardio-Oncology Programs in the New Era: Beyond Ventricular Dysfunction Due to Cancer Treatments. Cancers (Basel) 2023; 15:5885. [PMID: 38136428 PMCID: PMC10742309 DOI: 10.3390/cancers15245885] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
Cardiovascular disease is a common problem in cancer patients that is becoming more widely recognized. This may be a consequence of prior cardiovascular risk factors but could also be secondary to the anticancer treatments. With the goal of offering a multidisciplinary approach to guaranteeing optimal cancer therapy and the early detection of related cardiac diseases, and in light of the recent ESC Cardio-Oncology Guideline recommendations, we developed a Cardio-Oncology unit devoted to the prevention and management of these specific complications. This document brings together important aspects to consider for the development and organization of a Cardio-Oncology program through our own experience and the current evidence.
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Affiliation(s)
- Alexandra Pons-Riverola
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Herminio Morillas
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Javier Berdejo
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Sonia Pernas
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Medical Oncology Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Helena Pomares
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Clinical Haematology Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Leyre Asiain
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Radiation Oncology Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Alberto Garay
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Adela Fernandez-Ortega
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Medical Oncology Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Ana Carla Oliveira
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Clinical Haematology Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Haematopoietic and Lymphoid Tumours Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Evelyn Martínez
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Radiation Oncology Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Radiobiology and Cancer Group, ONCOBELL Program, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Santiago Jiménez-Marrero
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Elena Pina
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Thrombosis and Haemostasis Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Eduard Fort
- Pharmacy Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain;
| | - Raúl Ramos
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Lídia Alcoberro
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Encarnación Hidalgo
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
| | - Maite Antonio-Rebollo
- Oncogeriatrics Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain;
| | - Laia Alcober
- Primary Care Service Delta del Llobregat and IDIAP, Catalan Health Service, 08007 Barcelona, Spain;
| | - Cristina Enjuanes Grau
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Josep Comín-Colet
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Pedro Moliner
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
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Cristóbal H, Enjuanes C, Batlle M, Tajes M, Campos B, Francesch J, Moliner P, Farrero M, Andrea R, Ortiz-Pérez JT, Morales A, Sabaté M, Comin-Colet J, García de Frutos P. Prognostic Value of Soluble AXL in Serum from Heart Failure Patients with Preserved and Reduced Left Ventricular Ejection Fraction. J Pers Med 2023; 13:446. [PMID: 36983628 PMCID: PMC10056687 DOI: 10.3390/jpm13030446] [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: 12/23/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/05/2023] Open
Abstract
Heart failure (HF) is classified according to the degree of reduction in left ventricular ejection fraction (EF) in HF with reduced, mildly reduced, and preserved EF. Biomarkers could behave differently depending on EF type. Here, we analyze the soluble form of the AXL receptor tyrosine kinase (sAXL) in HF patients with reduced and preserved EF. Two groups of HF patients with reduced (HFrEF; n = 134) and preserved ejection fraction (HFpEF; n = 134) were included in this prospective observational study, with measurements of candidate biomarkers and functional, clinical, and echocardiographic variables. A Cox regression model was used to determine predictors for clinical events: cardiovascular mortality and all-cause mortality. sAXL circulating values predicted outcome in HF: for a 1.0 ng/mL increase in serum sAXL, the mortality hazard ratio (HR) was 1.019 for HFrEF (95% CI 1.000 to 1.038) and 1.032 for HFpEF (95% CI 1.013 to 1.052). In a multivariable Cox regression analysis, sAXL and NT-proBNP were independent markers for all-cause and cardiovascular mortality in HFpEF. In contrast, only NT-proBNP remained significant in the HFrEF group. When analyzing the event-free survival at a mean follow-up of 3.6 years, HFrEF and HFpEF patients in the higher quartile of sAXL had a reduced survival time. Interestingly, sAXL is a reliable predictor for all-cause and cardiovascular mortality only in the HFpEF cohort. The results suggest an important role for AXL in HFpEF, supporting sAXL evaluation in larger clinical studies and pointing to AXL as a potential target for HF therapy.
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Affiliation(s)
- Helena Cristóbal
- Department of Cell Death and Proliferation, Institute of Biomedical Research of Barcelona (IIBB-CSIC), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), E08036 Barcelona, Spain
| | - Cristina Enjuanes
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, E08907 L’Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), E08907 L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), E28029 Madrid, Spain
| | - Montserrat Batlle
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), E28029 Madrid, Spain
- Cardiology Department, Clinical Cardiovascular Institute, Hospital Clinic and IDIBAPS, University of Barcelona, E08036 Barcelona, Spain
| | - Marta Tajes
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, E08907 L’Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), E08907 L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), E28029 Madrid, Spain
| | - Begoña Campos
- Department of Basic Clinical Practice, Universitat de Barcelona, E08036 Barcelona, Spain
| | - Josep Francesch
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), E08907 L’Hospitalet de Llobregat, Spain
| | - Pedro Moliner
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, E08907 L’Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), E08907 L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), E28029 Madrid, Spain
| | - Marta Farrero
- Cardiology Department, Clinical Cardiovascular Institute, Hospital Clinic and IDIBAPS, University of Barcelona, E08036 Barcelona, Spain
| | - Rut Andrea
- Cardiology Department, Clinical Cardiovascular Institute, Hospital Clinic and IDIBAPS, University of Barcelona, E08036 Barcelona, Spain
| | - José Tomás Ortiz-Pérez
- Cardiology Department, Clinical Cardiovascular Institute, Hospital Clinic and IDIBAPS, University of Barcelona, E08036 Barcelona, Spain
| | - Albert Morales
- Department of Cell Death and Proliferation, Institute of Biomedical Research of Barcelona (IIBB-CSIC), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), E08036 Barcelona, Spain
| | - Manel Sabaté
- Cardiology Department, Clinical Cardiovascular Institute, Hospital Clinic and IDIBAPS, University of Barcelona, E08036 Barcelona, Spain
| | - Josep Comin-Colet
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, E08907 L’Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), E08907 L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), E28029 Madrid, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, E08036 Barcelona, Spain
| | - Pablo García de Frutos
- Department of Cell Death and Proliferation, Institute of Biomedical Research of Barcelona (IIBB-CSIC), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), E08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), E28029 Madrid, Spain
- Hospital del Mar Medical Research Institute (IMIM) and IIBB-CSIC Associated RDI Unit, E08036 Barcelona, Spain
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Alcoberro L, Moliner P, Vime J, Jiménez-Marrero S, Garay A, Yun S, Pons-Riverola A, Ramos-Polo R, Ras-Jiménez M, Tajes M, Hidalgo E, Calero E, Ruiz M, José-Bazán N, Ferre C, Delso C, Alcober L, Enjuanes C, Comin-Colet J. Breaking the 30-day barrier: Long-term effectiveness of a nurse-led 7-step transitional intervention program in heart failure. PLoS One 2023; 18:e0279815. [PMID: 36749763 PMCID: PMC9904494 DOI: 10.1371/journal.pone.0279815] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 12/15/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND AIMS Heart failure (HF) programs successfully reduce 30-day readmissions. However, conflicting data exist about its sustained effects afterwards and its impact on mortality. We evaluated whether the impact of a new nurse-led coordinated transitional HF program extends to longer periods of time, including 90 and 180 days after discharge. METHODS AND RESULTS We designed a natural experiment to undertake a pragmatical evaluation of the implementation of the program. We compared outcomes between patients discharged with HF as primary diagnosis in Period #1 (pre-program; Jan 2017-Aug 2017) and those discharged during Period #2 (HF program; Sept 2017-Jan 2019). Primary endpoint was the composite of all-cause death or all-cause hospitalization 90 and 180 days after discharge. 440 patients were enrolled: 123 in Period #1 and 317 in Period #2. Mean age was 75±9 years. There were more females in Period #2 (p = 0.025), with no other significant differences between periods. The primary endpoint was significantly reduced in the HF program group, at 90 [adjusted OR 0.31 (0.18-0.53), p <0.001] and at 180 days [adjusted OR 0.18 (CI 0.11-0.32), p <0.001]. Such a decrease was due to a reduction in cardiovascular (CV) and HF hospitalization. All-cause death was reduced when a double check discharge planning was implanted compared to usual care [0 (0%) vs. 7 (3.8%), p = 0.022]. CONCLUSION A new nurse-led coordinated transitional bundle of interventions model reduces the composite endpoint of all-cause death and all-cause hospitalization both at 90 and 180 days after a discharge for HF, also in high-risk populations. Such a decrease is driven by a reduction of CV and HF hospitalization. Reduction of all-cause mortality was also observed when the full model including a more exhaustive discharge planning process was implemented.
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Affiliation(s)
- Lidia Alcoberro
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Pedro Moliner
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- * E-mail: (PM); (JC-C)
| | - Joan Vime
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Santiago Jiménez-Marrero
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Alberto Garay
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Yun
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Internal Medicine, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Alexandra Pons-Riverola
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Raúl Ramos-Polo
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Mar Ras-Jiménez
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Internal Medicine, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Tajes
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Encarna Hidalgo
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Esther Calero
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Ruiz
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria José-Bazán
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Carles Ferre
- Emergency Department Short-Stay Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Delso
- Institut Catala de la Salut, SAP Delta Primary Care Service, El Prat de Llobregat, Barcelona, Spain
| | - Laia Alcober
- Institut Catala de la Salut, SAP Delta Primary Care Service, El Prat de Llobregat, Barcelona, Spain
| | - Cristina Enjuanes
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Comin-Colet
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Institut Catala de la Salut, SAP Delta Primary Care Service, El Prat de Llobregat, Barcelona, Spain
- * E-mail: (PM); (JC-C)
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6
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Tapia J, Basalo M, Enjuanes C, Calero E, José N, Ruíz M, Calvo E, Garcimartín P, Moliner P, Hidalgo E, Yun S, Garay A, Jiménez-Marrero S, Pons A, Corbella X, Colet JC. Psychosocial factors partially explain gender differences in health-related quality of life in heart failure patients. ESC Heart Fail 2022; 10:1090-1102. [PMID: 36582154 PMCID: PMC10053343 DOI: 10.1002/ehf2.14260] [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] [Received: 06/12/2022] [Revised: 11/14/2022] [Accepted: 11/27/2022] [Indexed: 12/31/2022] Open
Abstract
AIMS There is little information about the influence of gender on quality of life (QoL) in heart failure. The purpose of this study was to evaluate whether the health-related QoL gap between men and women can be explained by the interaction between psychosocial factors and clinical determinants in a real-word cohort of patients with chronic heart failure. METHODS AND RESULTS We conducted a single-centre, observational, prospective cohort study of 1236 consecutive patients diagnosed with chronic heart failure recruited between 2004 and 2014. To assess QoL, we used the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Female gender was associated with worse global QoL compared to male gender (MLHFQ overall summary score: 49 ± 23 vs. 43 ± 24; P value <0.001, respectively) and similarly had poorer scores in physical and emotional dimensions but scored better on social dimension. In univariate models and in models adjusted for clinical determinants, female gender behaved as a predictor of worse global, physical and emotional QoL, and better social QoL compared with men. In models only including psychosocial determinants and in comprehensive models including all psychosocial and clinical factors, these differences according to gender were no longer significant. CONCLUSIONS In this study, we have shown that the gap in health-related QoL between men and women with chronic heart failure can be partially explained by the interaction between biological and psychosocial factors. Biological factors are the main drivers of QoL in HF patients. However, the contribution of psychosocial factors is essential to definitively understand the role of gender in this field.
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Affiliation(s)
- Javier Tapia
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - María Basalo
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Feixa Llarga, s/n, 08907, Barcelona, Spain
| | - Cristina Enjuanes
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Feixa Llarga, s/n, 08907, Barcelona, Spain.,Community Heart Failure Program (UMICO), Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Esther Calero
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Feixa Llarga, s/n, 08907, Barcelona, Spain.,Community Heart Failure Program (UMICO), Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria José
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Feixa Llarga, s/n, 08907, Barcelona, Spain.,Community Heart Failure Program (UMICO), Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Ruíz
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Feixa Llarga, s/n, 08907, Barcelona, Spain.,Community Heart Failure Program (UMICO), Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elena Calvo
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Feixa Llarga, s/n, 08907, Barcelona, Spain
| | - Paloma Garcimartín
- Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.,Escola Superior d'Enfermería del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Pedro Moliner
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Feixa Llarga, s/n, 08907, Barcelona, Spain.,Community Heart Failure Program (UMICO), Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Encarna Hidalgo
- Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Feixa Llarga, s/n, 08907, Barcelona, Spain.,Community Heart Failure Program (UMICO), Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Yun
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Community Heart Failure Program (UMICO), Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Internal Medicine Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alberto Garay
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Feixa Llarga, s/n, 08907, Barcelona, Spain.,Community Heart Failure Program (UMICO), Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Santiago Jiménez-Marrero
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Feixa Llarga, s/n, 08907, Barcelona, Spain.,Community Heart Failure Program (UMICO), Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alexandra Pons
- Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Feixa Llarga, s/n, 08907, Barcelona, Spain
| | - Xavier Corbella
- Internal Medicine Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Josep Comín Colet
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Feixa Llarga, s/n, 08907, Barcelona, Spain.,Community Heart Failure Program (UMICO), Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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7
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Yun Viladomat S, Enjuanes C, Calero-Molina E, Hidalgo E, Jose-Bazan N, Ruiz M, Jimenez-Marrero S, Garay A, Alcoberro L, Ras M, Ramos R, Pons-Riverola A, Moliner P, Comin-Colet J. Usefulness of telemedicine-based heart failure monitoring according to “eHealth literacy” domains: insights from the iCOR randomised controlled trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
The potential positive effect of electronic health (eHealth)-based heart failure (HF) monitoring remains uncertain, largely due to the heterogeneity of the studies published to date. A subgroup of patients in which its key role is particularly uncertain is in the “low literacy” or “computer or digital illiterate” patients mainly due to telemedicine (TM)-based strategies have been often discouraged on the basis of a foreseeable limited benefit in them.
Purpose
The aim of this study was to determine the effectiveness of a TM-based managed care solution across literacy levels and information and communications technology (ICT) skills.
Methods
We performed a sub-analysis on the basis of two literacy domains (traditional and computer literacy) encompassed in the definition of “eHealth literacy” to the HF-patients included in the “insuficiència Cardíaca Optimitzaciό Remota” (iCOR) randomised study comparing TM vs. usual care (UC) in HF-patients. The primary study endpoint was the incidence of a non-fatal HF event after 6 months of inclusion. The event rates of primary (the occurrence of non-fatal HF event) and secondary (all-cause hospitalization, all cause death and the composite endpoint combining of allcause death or non-fatal HF events) study endpoints were calculated for each literacy domains and its combination. Cox proportional-hazards regression models were used to evaluate the effect of “eHealth literacy” dimensions, treatment group and the interaction term “eHealth literacy” domains by treatment group on study endpoints, and p-value was used to compare the different curves.
Results
178 patients were analysed (81 TM vs 90 UC). As far as the “traditional literacy” analyses, 65% of patients had only elementary education and the 6% had no literacy qualifications, defining the low-educated subgroup as “lower literacy” (126 patients, 71%). All the other patients were classified in the “middle or higher literacy” (52 patients, 29%) subgroup. Moreover, concerning new technological management, 128 patients (72%) referred presenting moderate to high difficulties in its handling, constituting the “lower ICT skills” subgroup. The remaining 28% (50 patients) were allocated into the “middle or higher ICT skills” subgroup due to their minor handicap in their ICT use.
The beneficial effect of TM compared to UC strategy was consistent across all literacy domains (pvalue for interaction 0.207 and 0.117 respectively). The risk of experiencing a primary event was significantly lower in patients that underwent allocation to the TM arm compared to UC in both clustered in the “lower literacy” (p-value=0.001) (Picture 1) and those allocated to the “lower ICT skills” (p-value=0.001) (Picture 2) subgroup.
Conclusions
Non-invasive eHealth-based HF monitoring tools are effective compared to UC in preventing HF events in the early post-discharge period, regardless of two “eHealth literacy” domains (“traditional and computer literacy”).
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Yun Viladomat
- Bellvitge University Hospital, Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), , Hospitalet De Llobregat , Spain
| | - C Enjuanes
- Bellvitge University Hospital, Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), , Hospitalet De Llobregat , Spain
| | - E Calero-Molina
- Bellvitge University Hospital, Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), , Hospitalet De Llobregat , Spain
| | - E Hidalgo
- Bellvitge University Hospital, Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), , Hospitalet De Llobregat , Spain
| | - N Jose-Bazan
- Bellvitge University Hospital, Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), , Hospitalet De Llobregat , Spain
| | - M Ruiz
- Bellvitge University Hospital, Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), , Hospitalet De Llobregat , Spain
| | - S Jimenez-Marrero
- Bellvitge University Hospital, Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), , Hospitalet De Llobregat , Spain
| | - A Garay
- Bellvitge University Hospital, Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), , Hospitalet De Llobregat , Spain
| | - L Alcoberro
- Bellvitge University Hospital, Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), , Hospitalet De Llobregat , Spain
| | - M Ras
- Bellvitge University Hospital, Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), , Hospitalet De Llobregat , Spain
| | - R Ramos
- Bellvitge University Hospital, Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), , Hospitalet De Llobregat , Spain
| | - A Pons-Riverola
- Bellvitge University Hospital, Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), , Hospitalet De Llobregat , Spain
| | - P Moliner
- Bellvitge University Hospital, Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), , Hospitalet De Llobregat , Spain
| | - J Comin-Colet
- Bellvitge University Hospital, Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), , Hospitalet De Llobregat , Spain
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8
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Jose-Bazan N, Jimenez-Marrero S, Calero-Molina E, Hidalgo-Quiros E, Enjuanes-Grau C, Ruiz-Munoz M, Ramos-Polo R, Ras M, Yun-Viladomat S, Alcoberro L, Garay A, Moliner P, Calvo E, Garcimartin P, Comin-Colet J. In heart failure, self-care behavior is an independent determinant of health-related quality of life, regardless of the severity of this patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Poor self-care behaviour is associated with a higher risk of readmission and mortality in patients with heart failure (HF). The interplay between self-care and patient-reported outcomes such as health-related quality of life (QoL) has not been fully established.
Purpose
To describe the association between self-care and QoL in real-world cohort of HF patients.
Methods
We conducted an observational, prospective, cohort study of 1120 consecutive patients with chronic HF. We used the modified European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure self-care. Scores were inverted and standardized (higher scores indicate better selfcare). To assess QoL, we used the Minnesota Living with Heart Failure Questionnaire (MLHFQ) (higher scores indicate worse QoL). Written informed consent, complete clinical and psychosocial information of patients were obtained at baseline. To determine the impact of global self-care and its dimensions (autonomy-based adherence, consulting behaviour and provider-based adherence), multivariate linear regressions models (backwards stepwise methods) to predict
QoL were constructed. The multivariate parametric and non-parametric associations between EHFSCBS-9 scoresand the β estimated risk of impairment of QoL (defined as MLHFQ scores ≥ median values) were explored using General Additive Models (GAM). All models were adjusted by age, sex and prognostic factors such as LVEF, NYHA, NT-proBNP levels and recent hospitalization among other well-known determinants of HF severity.
Results
A total of 484 patients (43%) were women, mean age was 72±11 years, and mean LVEF was 45±17%. Mean MLHFQ scores were 45±24. Mean EHFSCBS-9 scores were 69±28. There was a significant inverse correlation between EHFScBS-9 and MLHFQ scores (r=−0.158; p-value<0.0001). As shown in Table 1, self-care behaviour and its 3 domains were independent predictors of QoL in 7 out of the 16 associations explored. These models confirmed a weak linear relationship between EHFSCBS-9 scores and MLHFQ scores particularly between global selfcare and consulting behaviour dimension with global, emotional and social dimensions of QoL. Interestingly, when QoL was dichotomized as impaired/preserved QoL, GAM showed a significant non-parametric “U-shape” relationship (p-value<0.05) between EHFScBS-9 scores and the risk of impairment in QoL (Figure 1).
Conclusions
We have shown that self-care behaviour is an independent predictor of health related QoL in HF regardless the level of disease severity. Global self-care and consulting behaviour were particularly and significantly associated with global QoL and emotional and social dimensions of QoL. Interestingly the relationship between self-care scores and the risk of impaired global QoL was non-linear showing a “U-shape” association pointing out that patients with extreme levels of self-care were more likely to experience impairments in QoL.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Jose-Bazan
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - S Jimenez-Marrero
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - E Calero-Molina
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - E Hidalgo-Quiros
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - C Enjuanes-Grau
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - M Ruiz-Munoz
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - R Ramos-Polo
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - M Ras
- Bellvitge University Hospital, Internal Medicine , Hospitalet De Llobregat , Spain
| | - S Yun-Viladomat
- Bellvitge University Hospital, Internal Medicine , Hospitalet De Llobregat , Spain
| | - L Alcoberro
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - A Garay
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - P Moliner
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - E Calvo
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | | | - J Comin-Colet
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
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9
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Jose-Bazan N, Jimenez-Marrero S, Calero-Molina E, Enjuanes-Grau C, Ruiz-Munoz M, Hidalgo-Quiros E, Ras M, Yun-Viladomat S, Alcoberro L, Ramos-Polo R, Garay A, Garcimartin P, Calvo E, Moliner P, Comin-Colet J. Fragility influences the impact of self-care behavior on patient-reported outcomes further of psychosocial factors of self-perceived health status in patients with heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Poor self-care behaviour is associated with a higher risk of readmission and mortality in patients with heart failure (HF). Psychosocial factors are key determinants of patient-reported outcomes (PROMs) such as health-realted quality of life (QoL). Little is known about the interplay between self-care and psychosocial factors on PROMs in HF.
Purpose
To describe the interaction of self-care and psycho-social factors on QoL in a real-world cohort of HF patients.
Methods
We conducted an observational, prospective, cohort study of 1120 consecutive patients with chronic. We used the modified European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure self-care (inverted and standardised: higher scores indicate better self-care). To assess QoL, we used Minnesota Living with Heart Failure Questionnaire (MLHFQ) (higher scores indicate worse QoL). General linear models (GLM) were constructed to explore the interaction between psychosocial factors and poor self-care (defined as EHFSCBS-9 ≤lower tertile) on adjusted MLHFQ scores. To determine the impact of self-care, multivariate linear regressions models to predict QoL were constructed stratified according to selected psycho-social determinants. All models were adjusted by age, sex and psycho-social determinants of QoL including literacy, cognitive function (Pfeiffer test), dependency (Barthel and Lawton & Brody test), social support (Duke UNC and APGAR Familyfunction), depressive symptoms (15-item Geriatric Depression Scale) and fragility (Barber test scores ≥1).
Results
A total of 484 patients (43%) were women, mean age was 72±11 years, and mean LVEF was 45±17%. Mean MLHFQ scores were 45±24. Mean EHFSCBS-9 scores were 69±28. There was a significant inverse correlation between EHFScBS-9 and MLHFQ scores (r=−0.158; p-value <0.0001). Fragility was present in 883 patients (79%). In adjusted GLM, poor self-care (F=10.2; p-value=0.001) and fragility (F=17.9; p-value <0.001) were independent predictors of higher adjusted scores in the MLHFQ indicating worse QoL. As shown in Figure 1, the interaction between fragility and self-care was significant (F=6.8; p-value = 0.009). Linear regression models (Table 1) stratified according the absence (panel A) or the presence (panel B) of fragility showed that fragility modulated the association between self-care behaviour and QoL. Only in patients without fragility, self-care were independent predictors of QoL. On the other hand, in patients with fragility, self-care behaviour did not longer influence self-perceived health status in patients with HF.
Conclusions
We have shown that self-care behaviour is an independent predictor of PROMs in HF regardless the presence of important psycho-social determinants of QoL only when fragility status is taken into account. Fragility modulates the influence of self-care and QoL, including each one of its dimensions.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Jose-Bazan
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - S Jimenez-Marrero
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - E Calero-Molina
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - C Enjuanes-Grau
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - M Ruiz-Munoz
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - E Hidalgo-Quiros
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - M Ras
- Bellvitge University Hospital, Internal Medicine , Hospitalet De Llobregat , Spain
| | - S Yun-Viladomat
- Bellvitge University Hospital, Internal Medicine , Hospitalet De Llobregat , Spain
| | - L Alcoberro
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - R Ramos-Polo
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - A Garay
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | | | - E Calvo
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - P Moliner
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - J Comin-Colet
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
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10
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Jose-Bazan N, Jimenez-Marrero S, Ramos-Polo R, Enjuanes-Grau C, Alcoberro L, Hidalgo-Quiros E, Ras M, Calero-Molina E, Ruiz-Munoz M, Yun-Viladomat S, Garay A, Moliner P, Garcimartin P, Calvo E, Comin-Colet J. DAMOCLES project show that cognitive function is a strong determinant of the influence of self-care behavior on health-related quality of life in patients with heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Poor self-care is associated with a poorer outcomes in patients with heart failure (HF). Psycho-social factors are determinants of patient-reported outcomes (PROMs) such as health-realted quality of life (QoL). However, little is known about the interplay between self-care and psychosocial factors such as cognitive function on PROMs in patients with HF.
Purpose
Describe the effect of self-care on QoL across cognitive function and explore whether the interaction between self-care and cognitive function may account for this effect.
Methods
1120 patients with chronic HF from DAMOCLES study were analyzed. We used the modified European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure self-care (inverted and standardised: higher scores indicate better self-care). To assess QoL, we used Minnesota Living with Heart Failure Questionnaire (MLHFQ) (higher scores indicate worse QoL). Cognitive function was evaluated using Mini-Mental State Examination (MMSE) and Short Portable Mental State Questionnaire (SPMSQ) Tests. Cognitive impairment was defined as abnormal age-and-literacy-adjusted scores. General linear models (GLM) were constructed to explore the interaction between cognitive function and poor self-care (defined as EHFSCBS-9 ≤lower tertile) on adjusted MLHFQ scores. To determine the impact self-care, multivariate linear regressions models to predict QoL were constructed stratified according to cognitive function. All models were adjusted by determinants of HF severity.
Results
Mean age was 72±11 years, 43% were women and mean LVEF was 45±17%. Lower MMSE scores (β=−0,163; p-value <0.001) and >3 errors in the SPMSQ indicating cognitive impairment (β=0.071; p-value = 0.023) were associated with higher scores in the MLHFQ. These associations were confirmed in multivariare linear regression models (β=0.062; p-value = 0.038). In adjusted GLM, poor global self-care (F=4.8; p-value = 0.029) was an independent predictor of higher adjusted scores in the MLHFQ. Interaction term poor self-care by cognitive impairment was significantly associated with MLHFQ scores (F=6.0; p-value=0.014; Figure 1). Multivariate linear regresion models (Table 1) stratified according the absence (panel A) or the presence (panel B) of cognitive impairment showed that cognitive function modulates the association between self-care behaviour and QoL. This effect was only seen in patients without cognitive impairment. In patients with cognitive dysfunction, self-care behaviour did not longer influence self-perceived health status in patients with HF.
Conclusions
Self-care behaviour is an independent predictor of PROMs in HF regardless cognitive disfunction. Cognitive function modulates 1) influence of global self-care and each one of its dimensions on emotional QoL and 2) impact of global self-care and consulting behaviour on global and social QoL.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Jose-Bazan
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - S Jimenez-Marrero
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - R Ramos-Polo
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - C Enjuanes-Grau
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - L Alcoberro
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - E Hidalgo-Quiros
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - M Ras
- Bellvitge University Hospital, Internal Medicine , Hospitalet De Llobregat , Spain
| | - E Calero-Molina
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - M Ruiz-Munoz
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - S Yun-Viladomat
- Bellvitge University Hospital, Internal Medicine , Hospitalet De Llobregat , Spain
| | - A Garay
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - P Moliner
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | | | - E Calvo
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - J Comin-Colet
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
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11
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Rivero Santana B, Caro Codon J, Juarez Olmos V, Martinez Monzonis A, Zatarain-Nicolas E, Moliner P, Cadenas Chamorro R, Severo Sanchez A, Valbuena Lopez S, Zamora Aunon P, Gomez Prieto P, Gonzalez Juanatey JR, Lopez-Sendon J, Lopez De Sa E, Lopez-Fernandez T. HFA-ICOS cardiovascular toxicity risk score validation in CARDIOTOX registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cancer therapy-related cardiovascular toxicity (CTox) is a growing medical problem and baseline cardiovascular (CV) risk assessment is recommended in all patients scheduled to receive potentially cardiotoxic cancer therapy. Based on literature review, the Heart Failure Association (HFA) Cardio-Oncology working group and the International Cardio-Oncology Society (ICOS) proposed a risk score to predict CTox but, it has not been validated.
Purpose
To validate the HFA-ICOS anthracycline risk assessment score in the CARDIOTOX registry cohort (NCT02039622).
Methods
The CARDIOTOX registry is a prospective multicenter study aiming at identifying factors related with CTox and assessing the utility of clinical, biochemical, and echo parameters for the early detection of CV disease during and after cancer therapy. A total of 1324 adult patients were prospectively included from April 2012 to October 2017. Data was collected at baseline, 3 weeks and 3, 6, 12, 18 and 24 months after initiation of treatment. Clinical follow-up was extended until January 2020. All patients receiving anthracycline chemotherapy were stratified according to HFA-ICOS risk score and Kaplan-Meier survival curves were analyzed to estimate the risk of all-cause mortality and anthracycline chemotherapy-related CV complications defined by HFA-ICOS risk score (left ventricular dysfunction (LVD), heart failure (HF) and arrhythmias).
Results
A total of 1066 patients were included in the analysis. Baseline characteristics are summarized in table 1. 571 patients (53.6%) meet low, 333 (31.2%) medium, 152 (14.3%) high and 10 (0.9%) very-high HFA-ICOS CTox risk criteria. 197 patients (18.4%) died of any cause during follow-up. CV death occurred in 4 patients (2%), all caused by HF. Any degree of CTox was identified in 519 (48.7%) patients during the 110 months follow-up (73 (6.8%) developed clinical HF/HF hospitalization, 29 (2.7%) asymptomatic LVEF <50%; 27 (2.5%) clinically relevant arrhythmias and 390 (36.6%) an asymptomatic increase in cardiac biomarkers or a relative decrease in GLS>15%). Figures 1A and 1B showed the cumulative mortality rate and CTox rate during follow-up. CTox and all-cause mortality rates increased significantly according to the estimated baseline HFA-ICOS score.
Conclusions
HFA-ICOS risk score categorizes patients according to their risk of developing anthracycline chemotherapy-related CTox, showing a good ability to predict both all-cause mortality and CTox.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Instituto de Salud Carlos III (PI13/00559).
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Affiliation(s)
- B Rivero Santana
- La Paz University Hospital, IdiPaz Research Institute , Madrid , Spain
| | - J Caro Codon
- La Paz University Hospital, IdiPaz Research Institute , Madrid , Spain
| | - V Juarez Olmos
- La Paz University Hospital, IdiPaz Research Institute , Madrid , Spain
| | - A Martinez Monzonis
- University Hospital of Santiago de Compostela, CiberCV , Santiago de Compostela , Spain
| | - E Zatarain-Nicolas
- Gregorio Maranon University General Hospital - Madrid Health Service, Complutense University, CIBER-CV (ISCIII) , Madrid , Spain
| | - P Moliner
- University Hospital Bellvitge , Barcelona , Spain
| | | | - A Severo Sanchez
- La Paz University Hospital, IdiPaz Research Institute , Madrid , Spain
| | - S Valbuena Lopez
- La Paz University Hospital, IdiPaz Research Institute , Madrid , Spain
| | - P Zamora Aunon
- University Hospital La Paz, Oncology Department. IdiPaz Research Institute. CIBER ONC , Madrid , Spain
| | - P Gomez Prieto
- University Hospital La Paz, Hematology Department. IdiPaz Research Institute , Madrid , Spain
| | - J R Gonzalez Juanatey
- University Hospital of Santiago de Compostela, CiberCV , Santiago de Compostela , Spain
| | - J Lopez-Sendon
- University Hospital La Paz, IdiPaz Research Institute. UAM , Madrid , Spain
| | - E Lopez De Sa
- La Paz University Hospital, IdiPaz Research Institute , Madrid , Spain
| | - T Lopez-Fernandez
- La Paz University Hospital, IdiPaz Research Institute , Madrid , Spain
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12
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Alcoberro L, Jimenez-Marrero S, Cainzos-Achirica M, Monterde D, Enjuanes C, Jose N, Garay A, Moliner P, Yun S, Ramos R, Ras M, Calero E, Hidalgo E, Corbella X, Comin-Colet J. Factors associated to renin-angiotensin-aldosterone system inhibitors discontinuation or down-titration due to hyperkalaemia in patients with chronic cardiovascular conditions. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
The renin-angiotensin-aldosterone system inhibitors (RAASI) are one of the keystones of the medical treatment in chronic cardiovascular disorders and have shown improvements in clinical outcomes in many clinical trials. Hyperkalaemia is a well-defined non-desirable effect of RAASI that occasionally forces to interrupt these medications. That enforced RAASI discontinuation or down-titration due to hyperkalaemia may have adverse prognostic consequences.
Purpose
Describe the demographical, clinical and pharmacological variables associated to a higher risk of RAASI discontinuation or down-titration due to hyperkalaemia among individuals with chronic cardiovascular conditions.
Methods
We used data from more than 375,000 individuals 55 years of age or older, included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. We included participants with at least one relevant condition: chronic heart failure, chronic kidney disease, diabetes mellitus, ischemic heart disease or hypertension. They had to be under RAASI treatment as of January 1st, 2016, and with evidence of at least one episode of hyperkalaemia (serum potassium >5.0 mmol/L) during 2016. Then, were classified in one of the two following profiles: RAASI treatment discontinuation or down-titration versus RAASI treatment unchanged or up-titrated. For the statistical analysis, we used logistic regression to calculate the multivariable-adjusted odds ratios of each study variable, comparing RAASI discontinuation or down-titration group to RAASI treatment unchanged or up-titrated controls (reference group).
Results
In the multivariable-adjusted model, the risk of RAASI treatment discontinuation or down-titration due to hyperkalaemia was significantly associated with the use of RAASI, very high comorbidity index, potassium derangements (both hypokalaemia and hyperkalaemia), prior hospitalizations and prior emergency visits. Among RAASI treatments, the use of Angiotensin receptor blockers (OR 2.518, 95% CI 2.317–2.735) and Angiotensin-converting enzyme inhibitors (OR 2.341, 95% CI 2.149–2.549) were associated with a higher risk of RAASI discontinuation or down-titration due to hyperkalaemia than Aldosterone inhibitors (1.428, 95% CI 1.285–1.584).
Conclusion
These results suggest that vulnerable populations such as those with very high comorbidity index, potassium derangements or prior emergency visits or hospitalizations have a higher risk of RAASI treatment discontinuation or down-titration due to hyperkalaemia.
A more careful and exhaustive management of RAASI should be advised in those patients.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Josep Comin-Colet has received speaker fees from Vifor Pharma.
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Affiliation(s)
- L Alcoberro
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - S Jimenez-Marrero
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | | | - D Monterde
- Department of Health , Barcelona , Spain
| | - C Enjuanes
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - N Jose
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - A Garay
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - P Moliner
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - S Yun
- Bellvitge University Hospital, Internal Medicine , Hospitalet De Llobregat , Spain
| | - R Ramos
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - M Ras
- Bellvitge University Hospital, Internal Medicine , Hospitalet De Llobregat , Spain
| | - E Calero
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - E Hidalgo
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - X Corbella
- Bellvitge University Hospital, Internal Medicine , Hospitalet De Llobregat , Spain
| | - J Comin-Colet
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
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13
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Jimenez-Marrero S, Cainzos-Achirica M, Monterde D, Enjuanes C, Garay A, Moliner P, Alcoberro L, Yun S, Ras M, Ramos R, Calero E, Hidalgo E, Jose N, Corbella X, Comin-Colet J. Management of renin-angiotensin-aldosterone system inhibitors in patients with chronic cardiovascular conditions and its association with clinical outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In chronic cardiovascular diseases, the renin-angiotensin-aldosterone system inhibitors (RAASI) are one of the keystones of the medical treatment and have revealed improvements in clinical outcomes in many clinical trials. In contrast, is well defined as non-desirable effect of RAASI the development of hyperkalemia, which could force to interrupt these treatments. Hyperkalemia has been associated with worse outcomes in observational studies. Though, it is controversial if those negative outcomes in hyperkalemic patients could be because the potassium derangement itself or the circumstance that in these individuals could be enforced to discontinue RAASI medications with prognostic consequences at mid- to long-term.
Purpose
Assess associations between management of RAASI and clinical outcomes among individuals with chronic cardiovascular conditions and hyperkalemia.
Methods
Data from more than 375,000 individuals 55 years of age or older were analyzed, in a population-based healthcare database of a public Institute of Health between 2015 and 2017. We conducted a longitudinal analysis, in which participants with at least one relevant condition were included: chronic heart failure, chronic kidney disease, diabetes mellitus, ischemic heart disease or hypertension. They had to be under RAASI treatment as of January 1st, 2016, and with evidence of at least one episode of hyperkalemia (serum potassium >5.0 mmol/L) during 2016. Then, were classified in one of the two following profiles: RAASI treatment discontinuation or down-titration versus RAASI treatment unchanged or up-titrated. Subsequently, all-cause death and hospitalization has been assessed in the follow-up period as clinical outcomes. For the statistical analysis, we calculated unadjusted incidence rate ratios and Cox Proportional Hazards Regression models to calculate the multivariable-adjusted risk ratios for the clinical endpoints comparing both groups.
Results
There was found an association with mortality and hospitalization for the RAASI treatment interruption/down-titration group when compared unadjusted incidence rate ratios of each clinical endpoints to RAASI treatment unchanged patients (reference group). We presented these results in a Kaplan-Meier survivor curves for endpoint mortality (Figure 1). In the multivariable-adjusted model, the risk of mortality and hospitalization was associated mainly with older age, hypokalemia and down-titration of RAASI treatments, achieving statistical significance (Table 1). The risk ratio for mortality associated with down-titration and with hyperkalemia compared with the reference group was 1.676 (95% CI 1.54–1.82) and 1.161 (95% CI 1.07–1.26) respectively.
Conclusion
These results suggest that the worse outcomes in hyperkalemia individuals could be influenced more for the discontinuation of RAASI prognostic drugs then for the hyperkalemia itself. It is necessary clinical randomized trials to confirm this observational hypothesis.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Josep Comin-Colet has received speaker fees from Vifor Pharma
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Affiliation(s)
| | | | - D Monterde
- Department of Health , Barcelona , Spain
| | - C Enjuanes
- University Hospital of Bellvitge, Cardiology , Barcelona , Spain
| | - A Garay
- University Hospital of Bellvitge, Cardiology , Barcelona , Spain
| | - P Moliner
- University Hospital of Bellvitge, Cardiology , Barcelona , Spain
| | - L Alcoberro
- University Hospital of Bellvitge, Cardiology , Barcelona , Spain
| | - S Yun
- University Hospital of Bellvitge, Internal Medicine , Barcelona , Spain
| | - M Ras
- University Hospital of Bellvitge, Internal Medicine , Barcelona , Spain
| | - R Ramos
- University Hospital of Bellvitge, Cardiology , Barcelona , Spain
| | - E Calero
- University Hospital of Bellvitge, Cardiology , Barcelona , Spain
| | - E Hidalgo
- University Hospital of Bellvitge, Cardiology , Barcelona , Spain
| | - N Jose
- University Hospital of Bellvitge, Cardiology , Barcelona , Spain
| | - X Corbella
- University Hospital of Bellvitge, Internal Medicine , Barcelona , Spain
| | - J Comin-Colet
- University Hospital of Bellvitge, Cardiology , Barcelona , Spain
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14
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Comin-Colet J, Capdevila C, Vela E, Cleries M, Fernandez C, Alcober L, Calero-Molina E, Hidalgo E, Jose N, Moliner P, Corbella X, Yun S, Jimenez-Marrero S, Garay A, Enjuanes-Grau C. Effect on mortality and hospitalization of real-world implementation of transitional care heart failure programmes in patients with heart failure: a population-based study in 77,554 patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The efficacy of heart failure programs has been demonstrated in clinical trials but their applicability in the real-world practice setting is more controversial.
Purpose
This study evaluates the efficacy of a comprehensive, transitional-care nurse-based HF programme integrating hospital and primary care resources in a healthcare area covering a population of 209,255 (implementation area).
Methods
We designed a pragmatic, population-based evaluation of the implementation of the program conducting a natural experiment. Study periods were: pre-implementation period (years 2015 and 2016), transition period (year 2017) and consolidation of implementation period (years 2018 and 2019). For the purposes of this study, we included all individuals consecutively admitted to hospital with at least one ICD-9-CM code for HF as the primary diagnosis and discharged alive in Catalonia between January, the 1st, 2015 and December, the 31st of 2019. Efficacy of the implementation of the program was measured at two levels: first, comparing the outcomes of patients exposed to the HF program between periods of implementation taking 2015–2016 as the reference period and, second, comparing outcomes between patients of the implementation area with patients of the remaining areas of the Catalonia at each predefined period.
Results
We included 77,554 patients in the study: 3,396 exposed to the implementation area and 74,158 exposed to the rest of healthcare areas in Catalonia. During the period of the study, 55,886 (72.1%) patients experienced at least one major adverse event. Death occurred in 37,469 (48.3%), clinically related hospitalisation in 41,709 (53.8%) and HF readmission in 29,755 (38.4%).
As shown in Table 1, multivariate Cox proportional hazards models adjusted for age, gender, previous hospitalisation, co-morbidities, socioeconomic status, and time since HF diagnosis showed there was a significant (all p-values <0.001) relative risk reduction of the risk of all-cause death (5%), clinically related hospitalisation (13%) and HF hospitalisation (14%) in the consolidation period (2018–2019) compared to the pre-programme period (2015–2016). Similarly, as shown in Table 1 and Figure 1, while in the pre-programme period (2015–2016) the risk of adverse outcomes was significantly higher in patients exposed to the implementation area compared to the rest of Catalonia, this association was inverted during the consolidation period (2018–2019) where the risk of mortality, clinically-related readmission and HF re-hospitalisation was significantly reduced (all p-values <0.025) by 19%, 11% and 16%, respectively, among patients exposed to the implementation area compared with patients of the remaining areas of Catalonia.
Conclusions
The implementation of multidisciplinary transitional-care nurse-based heart failure programmes integrating hospital and primary care reduce mortality and hospitalisation in vulnerable patients with heart-failure.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - C Capdevila
- University Hospital Bellvitge , Barcelona , Spain
| | - E Vela
- Department of Health , Barcelona , Spain
| | - M Cleries
- Department of Health , Barcelona , Spain
| | - C Fernandez
- Primary Care Research Institute (IDIAP) , Barcelona , Spain
| | - L Alcober
- Primary Care Research Institute (IDIAP) , Barcelona , Spain
| | | | - E Hidalgo
- University Hospital Bellvitge , Barcelona , Spain
| | - N Jose
- University Hospital Bellvitge , Barcelona , Spain
| | - P Moliner
- University Hospital Bellvitge , Barcelona , Spain
| | - X Corbella
- University Hospital Bellvitge , Barcelona , Spain
| | - S Yun
- University Hospital Bellvitge , Barcelona , Spain
| | | | - A Garay
- University Hospital Bellvitge , Barcelona , Spain
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15
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Fort E, Otero S, Moliner P, Bleda C, Prats J, Nadal E, Palmero R, Jimenez L, Piulats JM, Rey M, Fontanals S. Incidence of drug-drug interactions of QT-prolonging drugs in an onco-hematological outpatient. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Oral anticancer therapy is increasingly integrated into the care of patients (pts) with cancer. Recognition and management of pharmacodynamic drug-drug interactions is critical to provide efficacious and safe anticancer treatment.
Purpose
We aimed to gain insight into the real-world prevalence of potentially significant drug-drug interactions of QT-prolonging with oral antineoplastic agents used in an Oncohematological Hospital
Methods
We performed a prospective observational study in an oncohematological hospital between October 2020 and June 2021. Consecutive pts diagnosed with an oncohematological neoplasia and who were evaluated before start treatment with an oral anticancer drug or suport treatment (antibiotics, antivirals) were included. Cancer treatment data were obtained from our prescription software System. Demographic data and concomitant medication were obtained from our electronic medical record software. Micromedex was used to find potencial QT-prolonging interactions between anticancer drugs and chronic medication, and were classified as major or moderate.
Results
Oncohematological treatment was started in 1.217 pts during the study period. A total of 266 potential drug-drug interactions were detected in 171 patients (14.5%). A total of 46 drug-drug interactions of QT-prolonging (17.3%) were detected in 37 pts (21.6%), 22 men and 15 women, with a median age of 66.6 (range 40.9–87.3). Twenty-one (45.7%) and 25 (56.3%) drug interactions of QT-prolonging were classified as major and moderate, respectively, with a median interaction per pts 1.24 (1–3). The 3 most common cancers were: Renal carcinoma in 12 pts (32.4%), non-small cell lung carcinoma in 9 pts (24.7%) and prostate carcinoma in 4 pts (10.8%). The most commonly detected interacting drugs were sunitinib 12 pts (26.1%), osimertinib 10 pts (21.7%), and cabozantinib 5 pts (10.9%) among oncohematological drugs, and citalopram 8 (17.4%), quetiapine 6 (13%) and tramadol 5 (10.8%) among concomitant drugs.
Conclusion
Drug-drug interactions can play a significant role in drugs' cardiac safety in oncohematological pts, specially in renal, lung and prostate cancers, with more than one potential interacting drug or at least one major interaction. Cardiac monitorizacion should be considered when potential drug drug interaction is detected.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Fort
- Catalan Institute of Oncology , Barcelona , Spain
| | - S Otero
- Catalan Institute of Oncology , Barcelona , Spain
| | - P Moliner
- Catalan Institute of Oncology , Barcelona , Spain
| | - C Bleda
- Catalan Institute of Oncology , Barcelona , Spain
| | - J Prats
- Catalan Institute of Oncology , Barcelona , Spain
| | - E Nadal
- Catalan Institute of Oncology , Barcelona , Spain
| | - R Palmero
- Catalan Institute of Oncology , Barcelona , Spain
| | - L Jimenez
- Catalan Institute of Oncology , Barcelona , Spain
| | - J M Piulats
- Catalan Institute of Oncology , Barcelona , Spain
| | - M Rey
- Catalan Institute of Oncology , Barcelona , Spain
| | - S Fontanals
- Catalan Institute of Oncology , Barcelona , Spain
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16
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Comin-Colet J, Capdevila C, Vela E, Cleries M, Fernandez C, Alcober L, Calero-Molina E, Hidalgo E, Jose N, Moliner P, Corbella X, Yun S, Jimenez-Marrero S, Garay A, Enjuanes-Grau C. Effect of socioeconomic status in medical resource use and outcomes in patients with heart failure in integrated care settings: real-world evidence from population-based data of 77,554 patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Low socioeconomic status (SES) has a negative impact in terms of outcomes and medical resource use despite open access to care in universal health-care systems in patients with heart failure (HF). Whether the breach in outcomes determined by SES inequalities can be mitigated by intensive HF management in integrate care programs is not known.
Purpose
To analyse the effect of SES status on health outcomes before and after a pragmatic implementation of an intensive transitional care nurse-based HF management program integrating hospital and primary care and resources for patients with HF at a high risk of events in a health-care area of 209,255 inhabitants.
Methods
For the purposes of this study, we included all individuals consecutively admitted to hospital with at least one ICD-9-CM code for HF as the primary diagnosis and discharged alive in Catalonia between January, the 1st, 2015 and December, the 31st of 2019. We considered 3 distinct periods of implementation of the HF programme: pre-implementation (2015–2016), transition (2017 start of implementation) and consolidation (2018–2019). To evaluate the efficacy of the programme according to SES strata, we compared outcomes between HF patients of the implementation area and HF patients of the remaining healthcare areas of Catalonia across implementation periods and stratified according to levels of SES. SES was defined based on individual annual income.
Results
We included 77,554 patients in the study: 3,396 in the implementation area and 74, 158 in the rest of Catalonia. Distribution of patients according to SES was: 12,018 (15.5%) high or medium SES, 61,967 (79.9%) low SES and 3,535 (4.5%) very low SES. During the period of the study death occurred in 37,469 (48.3%), clinically related hospitalisation in 41,709 (53.8%) and HF readmission in 29,755 (38.4%).
Multivariate Cox proportional hazards models (Table 1) showed that low or very low SES was associated with worse outcomes compared to patients with high or medium SES. Implementation of HF programme significantly improved outcomes in patients with HF (Figure 1, left column). As shown in Figure 1 central and right columns, improvement in clinical outcomes was observed across all SES strata in patients exposed to the HF programme. The size effect for hospitalisation was more prominent among patients with medium of high SES (47% relative change) compared to patients with low or very low SES (32% relative change). Size effect for mortality did not differ between both strata (10% relative improvement in both groups).
Conclusions
The SES is an independent predictor of mortality, clinically related hospitalisation, and HF hospitalisation in vulnerable patients with HF. The implementation of an intensive transitional care nurse-based HF management program improve clinical outcomes across SES strata. However, the size effect in the prevention of hospitalisation is more pronounced among patients with medium or high SES.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - C Capdevila
- University Hospital Bellvitge , Barcelona , Spain
| | - E Vela
- Department of Health , Barcelona , Spain
| | - M Cleries
- Department of Health , Barcelona , Spain
| | - C Fernandez
- Primary Care Research Institute (IDIAP) , Barcelona , Spain
| | - L Alcober
- Primary Care Research Institute (IDIAP) , Barcelona , Spain
| | | | - E Hidalgo
- University Hospital Bellvitge , Barcelona , Spain
| | - N Jose
- University Hospital Bellvitge , Barcelona , Spain
| | - P Moliner
- University Hospital Bellvitge , Barcelona , Spain
| | - X Corbella
- University Hospital Bellvitge , Barcelona , Spain
| | - S Yun
- University Hospital Bellvitge , Barcelona , Spain
| | | | - A Garay
- University Hospital Bellvitge , Barcelona , Spain
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Jose-Bazan N, Jimenez-Marrero S, Calero-Molina E, Moliner P, Hidalgo-Quiros E, Garay A, Ruiz-Munoz M, Ramos-Polo R, Enjuanes-Grau C, Yun-Viladomat S, Calvo E, Alcoberro L, Garcimartin P, Ras M, Comin-Colet J. In patients with chronic heart failure, there have been no gender differences in the impact of self behavior on patient-reported outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Poor self-care behaviour is associated with a higher risk in heart failure (HF). Gender is a determinant of patient-reported outcomes (PROMs) such as health-realted quality of life (QoL) in HF. Female gender is consistently associated with worse QoL. Whether gender may influence the effect of self-care on PROMS is not known.
Purpose
Describe the effect of self-care on QoL according to gender in a real world cohort of HF patients.
Methods
1120 patients with chronic HF were analysed. We used the modified European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure self-care (inverted and standardised: higher scores indicate better self-care). To assess QoL, we used Minnesota Living with Heart Failure Questionnaire (MLHFQ) (higher scores indicate worse QoL). General linear models (GLM) were constructed to explore the interaction between gender and poor self-care (defined as EHFSCBS-9 ≤lower tertile) on adjusted MLHFQ scores. To determine the impact of global self-care and its dimensions, multivariate linear regressions models to predict QoL were constructed stratified according to gender. All models were adjusted by determinants of HF severity.
Results
Mean age was 72±11 years, 43% were women and mean LVEF was 45±17%. There was a significant inverse correlation between EHFScBS-9 and MLHFQ scores (r=−0.158; p-value<0.0001). Unadjusted MLHFQ scores were consistenly higher in women compared to men (49±23 vs. 43±24; p-value<0.001). In adjusted GLM, female gender (F=4.8; p-value=0.028) and poor global self-care (F=12.6; p-value<0.001) were independent predictors of higher adjusted scores in MLHFQ, indicating worse global QoL. As shown in Figure 1, the interaction term gender by poor self-care was not significantly associated with MLHFQ scores in adjusted GLM (F=0.018; p-value=0.893): the gap between women and men in terms of QoL was observed in both self-care strata and the effect of self care on QoL was observed in both genders. Multivariate linear regresion models (Table 1) stratified according to female gender (panel A) or male gender (panel B) showed that higher scores in the EHFScBS-9 were associated with lower scores in the MLHFQ in women and men. This effect (Table 1) was equally seen in both genders for global QoL and was driven by global self-care, consulting behaviour, and in a lesser extent by autonomy-baseda dherence. The physical dimension of QoL was not affected by self-care in either women or men except for consulting behaviour.
Conclusions
Self-care is an independent predictor of health-related QoL in HF, regardless of the level of disease severity. Global self-care, autonomy-based adherence and consulting behaviour were particularly associated with global QoL and emotional and social dimensions of QoL in women and men. In both genders, the effect of self-care on QoL was driven by its effect on emotional and social dimensions. Provider-based adherence did not influence QoL.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Jose-Bazan
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - S Jimenez-Marrero
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - E Calero-Molina
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - P Moliner
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - E Hidalgo-Quiros
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - A Garay
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - M Ruiz-Munoz
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - R Ramos-Polo
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - C Enjuanes-Grau
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - S Yun-Viladomat
- Bellvitge University Hospital, Internal Medicine , Hospitalet De Llobregat , Spain
| | - E Calvo
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - L Alcoberro
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | | | - M Ras
- Bellvitge University Hospital, Internal Medicine , Hospitalet De Llobregat , Spain
| | - J Comin-Colet
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
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Ramos R, Moliner P, Comin-Colet J. Renin-angiotensin-aldosterone inhibition in chronic heart failure: From theory into practice. Eur J Intern Med 2022; 102:40-42. [PMID: 35787970 DOI: 10.1016/j.ejim.2022.06.019] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Raúl Ramos
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, 19th Floor. Feixa Llarga s/n, L'Hospitalet de Llobregat, Barcelona 08907, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Cardio-Oncology Unit, Cardiology Department, Bellvitge University Hospital and Catalan Institute of Oncology (ICO), L'Hospital de Llobregat, Barcelona, Spain.
| | - Pedro Moliner
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, 19th Floor. Feixa Llarga s/n, L'Hospitalet de Llobregat, Barcelona 08907, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Cardio-Oncology Unit, Cardiology Department, Bellvitge University Hospital and Catalan Institute of Oncology (ICO), L'Hospital de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
| | - Josep Comin-Colet
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, 19th Floor. Feixa Llarga s/n, L'Hospitalet de Llobregat, Barcelona 08907, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
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19
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Moliner P, Comin-Colet J. Iron deficiency and supplementation therapy in heart failure. Nat Rev Cardiol 2022; 19:571-572. [PMID: 35788563 DOI: 10.1038/s41569-022-00747-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Pedro Moliner
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Josep Comin-Colet
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain. .,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain. .,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
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20
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Yun S, Enjuanes C, Calero-Molina E, Hidalgo E, José-Bazán N, Ruiz M, Verdú-Rotellar JM, Garcimartín P, Jiménez-Marrero S, Garay A, Ras M, Ramos R, Pons-Riverola A, Moliner P, Corbella X, Comín-Colet J. Usefulness of telemedicine-based heart failure monitoring according to 'eHealth literacy' domains: Insights from the iCOR randomized controlled trial. Eur J Intern Med 2022; 101:56-67. [PMID: 35483994 DOI: 10.1016/j.ejim.2022.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The potential positive effect of electronic health (eHealth)-based heart failure (HF) monitoring remains uncertain mainly in the 'low literacy' or 'computer or digital illiterate' patients. The aim of this study was to determine the effectiveness of a telemedicine (TM)-based managed care solution across literacy levels and information and communications technology (ICT) skills. METHODS We performed a sub-analysis on the basis of two literacy domains encompassed in the definition of 'eHealth literacy' to the HF-patients included in the 'insuficiència Cardíaca Optimització Remota' (iCOR) randomized study comparing TM vs. usual care (UC) in HF-patients. The primary study endpoint was the incidence of a non-fatal HF event after 6 months of inclusion. The event rates of primary and secondary study endpoints were calculated for each literacy domains and its combination. Cox proportional-hazards regression models were used to evaluate the effect of 'eHealth literacy' dimensions, treatment group and the interaction term 'eHealth literacy' domains by treatment group on study endpoints. RESULTS The beneficial effect of TM compared to UC strategy was consistent across all literacy domains (p-value for interaction 0.207 and 0.117 respectively). The risk of experiencing a primary event was significantly lower in patients that underwent allocation to the TM arm compared to UC in both clustered in the 'lower literacy' (p-value=0.001) and those allocated to the 'lower ICT skills' (p-value=0.001) subgroup. CONCLUSIONS Non-invasive eHealth-based HF monitoring tools are effective compared to UC in preventing HF events in the early post-discharge period, regardless of two 'eHealth literacy' domains ('traditional and computer literacy').
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Affiliation(s)
- Sergi Yun
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Enjuanes
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Esther Calero-Molina
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Encarnación Hidalgo
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria José-Bazán
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Ruiz
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José María Verdú-Rotellar
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Jordi Gol Primary Care Research Institute, Catalan Institute of Heath, Barcelona, Spain
| | - Paloma Garcimartín
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Chief nursing officers. Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Escuela Superior de Enfermería del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Santiago Jiménez-Marrero
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Cardio-Oncology Unit. Bellvitge University Hospital and Catalan Institute of Oncology, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Alberto Garay
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Cardio-Oncology Unit. Bellvitge University Hospital and Catalan Institute of Oncology, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Mar Ras
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Raúl Ramos
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alexandra Pons-Riverola
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Moliner
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Cardio-Oncology Unit. Bellvitge University Hospital and Catalan Institute of Oncology, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Systemic Diseases and Ageing Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Hestia Chair in Integrated Health and Social Care, School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Josep Comín-Colet
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona (UB), Barcelona, Spain.
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21
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Yun S, Enjuanes C, Calero-Molina E, Hidalgo E, José N, Calvo E, Verdú-Rotellar JM, Garcimartín P, Chivite D, Formiga F, Jiménez-Marrero S, Garay A, Alcoberro L, Moliner P, Corbella X, Comín-Colet J. Effectiveness of telemedicine in patients with heart failure according to frailty phenotypes: Insights from the iCOR randomised controlled trial. Eur J Intern Med 2022; 96:49-59. [PMID: 34656406 DOI: 10.1016/j.ejim.2021.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The potential impact of telemedicine (TM) in the monitoring of patients with heart failure (HF) is still uncertain particularly in the frailest patients. The aim of this study was to define the efficacy of a TM-based managed care solution across different HF patient frailty phenotypes. METHODS We performed a clustering analysis on the basis of 8 frailty-related dimensions to the HF-patients included in the 'insuficiència Cardíaca Optimització Remota' (iCOR) randomised study comparing TM vs. usual care (UC) in HF patients. The primary study endpoint was the incidence of a non-fatal HF event after 6 months of inclusion. The healthcare-related costs in each study group and cluster were also evaluated. The event rates of primary and secondary study endpoints were calculated for each cluster. Cox proportional-hazards regression models were used to evaluate the effect of cluster, treatment group and the interaction term cluster by treatment group on study endpoints. RESULTS 5 different frailty phenotypes were identified. The positive effect of TM compared to UC strategy was consistent across all frailty phenotypes (p-value for interaction 0.711). The risk of experiencing a primary event was significantly lower in patients that underwent allocation to the TM arm compared to UC (p-value = 0.016). Ultimately, the healthcare costs were significantly reduced in patients allocated to the TM compared to UC in all 5 frailty phenotypes (all p-value < 0.05). CONCLUSIONS Non-invasive TM-based follow-up tools are effective compared to UC follow-up in preventing HF events in the early post-discharge period, regardless of the 5 frailty phenotypes.
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Affiliation(s)
- Sergi Yun
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Enjuanes
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Esther Calero-Molina
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Encarnación Hidalgo
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria José
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elena Calvo
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Faculty of medicine and Health Sciences, School of Nursing, University of Barcelona (UB), Barcelona, Spain
| | - José María Verdú-Rotellar
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Jordi Gol Primary Care Research Institute, Catalan Institute of Heath, Barcelona, Spain
| | - Paloma Garcimartín
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Outpatient Clinics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Escuela Superior de Enfermería del Mar, Parc de Salut Mar, Barcelona, Spain
| | - David Chivite
- Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francesc Formiga
- Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Santiago Jiménez-Marrero
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Cardio-Oncology Unit, Bellvitge University Hospital and Catalan Institute of Oncology, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Alberto Garay
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Cardio-Oncology Unit, Bellvitge University Hospital and Catalan Institute of Oncology, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Lídia Alcoberro
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Moliner
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Cardio-Oncology Unit, Bellvitge University Hospital and Catalan Institute of Oncology, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Hestia Chair in Integrated Health and Social Care, School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Josep Comín-Colet
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona (UB), Barcelona, Spain.
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22
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Díez-López C, Salazar-Mendiguchía J, García-Romero E, Fuentes L, Lupón J, Bayés-Genis A, Manito N, de Antonio M, Moliner P, Zamora E, Catalá-Ruiz P, Caínzos-Achirica M, Comín-Colet J, González-Costello J. Clinical Determinants and Prognosis of Left Ventricular Reverse Remodelling in Non-Ischemic Dilated Cardiomyopathy. J Cardiovasc Dev Dis 2022; 9:jcdd9010020. [PMID: 35050230 PMCID: PMC8778173 DOI: 10.3390/jcdd9010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/30/2021] [Accepted: 01/06/2022] [Indexed: 02/01/2023] Open
Abstract
Aims: Non-ischaemic dilated cardiomyopathy (NIDCM) is characterized by left ventricular (LV) chamber enlargement and systolic dysfunction in the absence of coronary artery disease. Left ventricular reverse remodelling (LVRR) is the ability of a dilated ventricle to restore its normal size, shape and function. We sought to determine the frequency, clinical predictors and prognostic implications of LVRR, in a cohort of heart failure (HF) patients with NIDCM. Methods: We conducted a multicentre observational, retrospective cohort study of patients with NIDCM, with prospective serial echocardiography evaluations. LVRR was defined as an increase of ≥15% in left ventricular ejection fraction (LVEF) or as a LVEF increase ≥ 10% plus reduction of LV end-systolic diameter index ≥ 20%. We used multivariable logistic regression analyses to identify the baseline clinical predictors of LVRR and evaluate the prognostic impact of LVRR. Results: LVRR was achieved in 42.5% of 527 patients with NIDCM during the first year of follow-up (median LVEF 49%, median change +22%), Alcoholic aetiology, HF duration, baseline LVEF and the absence of LBBB (plus NT-proBNP levels when in the model), were the strongest predictors of LVRR. During a median follow-up of 47 months, 134 patients died (25.4%) and 7 patients (1.3%) received a heart transplant. Patients with LVRR presented better outcomes, regardless of other clinical conditions. Conclusions: In patients with NIDCM, LVRR was frequent and was associated with improved prognosis. Major clinical predictors of LVRR were alcoholic cardiomyopathy, absence of LBBB, shorter HF duration, and lower baseline LVEF and NT-proBNP levels. Our study advocates for clinical phenotyping of non-ischaemic dilated cardiomyopathy and intense gold-standard treatment optimization of patients according to current guidelines and recommendations in specialized HF units.
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Affiliation(s)
- Carles Díez-López
- Advanced Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (C.D.-L.); (J.S.-M.); (E.G.-R.); (N.M.); (P.C.-R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.F.); (J.C.-C.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
- Department of Medicine, University of Barcelona, 08907 Barcelona, Spain
| | - Joel Salazar-Mendiguchía
- Advanced Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (C.D.-L.); (J.S.-M.); (E.G.-R.); (N.M.); (P.C.-R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.F.); (J.C.-C.)
| | - Elena García-Romero
- Advanced Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (C.D.-L.); (J.S.-M.); (E.G.-R.); (N.M.); (P.C.-R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.F.); (J.C.-C.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Lara Fuentes
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.F.); (J.C.-C.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Josep Lupón
- Heart Failure Unit, Department of Cardiology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.L.); (A.B.-G.); (E.Z.)
- CIBERCV (CB16/11/00403), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Antoni Bayés-Genis
- Heart Failure Unit, Department of Cardiology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.L.); (A.B.-G.); (E.Z.)
- CIBERCV (CB16/11/00403), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Nicolás Manito
- Advanced Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (C.D.-L.); (J.S.-M.); (E.G.-R.); (N.M.); (P.C.-R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.F.); (J.C.-C.)
| | - Marta de Antonio
- CIBERCV (CB16/11/00403), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Pedro Moliner
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
- Department of Medicine, University of Barcelona, 08907 Barcelona, Spain
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Elisabet Zamora
- Heart Failure Unit, Department of Cardiology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.L.); (A.B.-G.); (E.Z.)
- CIBERCV (CB16/11/00403), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Pablo Catalá-Ruiz
- Advanced Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (C.D.-L.); (J.S.-M.); (E.G.-R.); (N.M.); (P.C.-R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.F.); (J.C.-C.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Miguel Caínzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD 21093, USA;
- RTI Health Solutions, Pharmacoepidemiology and Risk Management, 08028 Barcelona, Spain
| | - Josep Comín-Colet
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.F.); (J.C.-C.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
- Department of Medicine, University of Barcelona, 08907 Barcelona, Spain
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - José González-Costello
- Advanced Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (C.D.-L.); (J.S.-M.); (E.G.-R.); (N.M.); (P.C.-R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.F.); (J.C.-C.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
- Department of Medicine, University of Barcelona, 08907 Barcelona, Spain
- Correspondence: ; Tel.: +34-932-607-078
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23
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Rubio R, Palacios B, Varela L, Fernández R, Camargo Correa S, Estupiñan MF, Calvo E, José N, Ruiz Muñoz M, Yun S, Jiménez-Marrero S, Alcoberro L, Garay A, Moliner P, Sánchez-Fernández L, Soria Gómez MT, Hidalgo E, Enjuanes C, Calero-Molina E, Rueda Y, San Saturnino M, Garcimartín P, López-Ibor JV, Segovia-Cubero J, Comin-Colet J. Quality of life and disease experience in patients with heart failure with reduced ejection fraction in Spain: a mixed-methods study. BMJ Open 2021; 11:e053216. [PMID: 34862295 PMCID: PMC8647550 DOI: 10.1136/bmjopen-2021-053216] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To gather insights on the disease experience of patients with heart failure (HF) with reduced ejection fraction (HFrEF), and assess how patients' experiences and narratives related to the disease complement data collected through standardised patient-reported outcome measures (PROMs). Also, to explore new ways of evaluating the burden experienced by patients and caregivers. DESIGN Observational, descriptive, multicentre, cross-sectional, mixed-methods study. SETTING Secondary care, patient's homes. PARTICIPANTS Twenty patients with HFrEF (New York Heart Association (NYHA) classification I-III) aged 38-85 years. MEASURES PROMs EuroQoL 5D-5L (EQ-5D-5L) and Kansas City Cardiomyopathy Questionnaire and patient interview and observation. RESULTS A total of 20 patients with HFrEF participated in the study. The patients' mean (SD) age was 72.5 (11.4) years, 65% were male and were classified inNYHA functional classes I (n=4), II (n=7) and III (n=9). The study showed a strong impact of HF in the patients' quality of life (QoL) and disease experience, as revealed by the standardised PROMs (EQ-5D-5L global index=0.64 (0.36); Kansas City Cardiomyopathy Questionnaire total symptom score=71.56 (20.55)) and the in-depth interviews. Patients and caregivers often disagreed describing and evaluating perceived QoL, as patients downplayed their limitations and caregivers overemphasised the poor QoL of the patients. Patients related current QoL to distant life experiences or to critical moments in their disease, such as hospitalisations. Anxiety over the disease progression is apparent in both patients and caregivers, suggesting that caregiver-specific tools should be developed. CONCLUSIONS PROMs are an effective way of assessing symptoms over the most recent time period. However, especially in chronic diseases such as HFrEF, PROM scores could be complemented with additional tools to gain a better understanding of the patient's status. New PROMs designed to evaluate and compare specific points in the life of the patient could be clinically more useful to assess changes in health status.
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Affiliation(s)
| | - Beatriz Palacios
- Medical Department, AstraZeneca Farmacéutica Spain SA, Madrid, Spain
| | - Luis Varela
- Medical Department, AstraZeneca Farmacéutica Spain SA, Madrid, Spain
| | - Raquel Fernández
- Medical Department, AstraZeneca Farmacéutica Spain SA, Madrid, Spain
| | | | | | - Elena Calvo
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
| | - Nuria José
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
| | - Marta Ruiz Muñoz
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
| | - Sergi Yun
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
| | - Santiago Jiménez-Marrero
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
| | - Lidia Alcoberro
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
| | - Alberto Garay
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Department of Cardio-Oncology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Pedro Moliner
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Department of Cardio-Oncology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Lydia Sánchez-Fernández
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Department of Cardio-Oncology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | | | - Encarna Hidalgo
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
| | - Cristina Enjuanes
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
| | - Esther Calero-Molina
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
| | | | | | - Paloma Garcimartín
- Outpatients Clinics, Hospital del Mar, Barcelona, Spain
- Department of Biomedical Research in Heart Diseases, Hospital del Mar Institute for Medical Research, Barcelona, Spain
| | - Jorge V López-Ibor
- Department of Cardiology, Puerta de Hierro University Hospital, Madrid, Spain
| | - Javier Segovia-Cubero
- Department of Cardiology, Puerta de Hierro University Hospital, Madrid, Spain
- CIBER of Cardiovascular Diseases, Carlos III Health Institute, Madrid, Spain
| | - Josep Comin-Colet
- Department of Cardiology and Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), Hospitalet de Llobregat, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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24
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Domingo M, Lupón J, Girerd N, Conangla L, de Antonio M, Moliner P, Santiago‐Vacas E, Codina P, Cediel G, Spitaleri G, González B, Diaz V, Rivas C, Velayos P, Núñez J, Bayes‐Genís A. Lung ultrasound in outpatients with heart failure: the wet-to-dry HF study. ESC Heart Fail 2021; 8:4506-4516. [PMID: 34725962 PMCID: PMC8712798 DOI: 10.1002/ehf2.13660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/26/2021] [Accepted: 09/27/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS In ambulatory patients with chronic heart failure (HF), congestion and decongestion assessment may be challenging. The aim of this study is to assess the value of lung ultrasound (LUS) in outpatients with HF in characterizing decompensation and recompensation, and in outcomes prediction. METHODS AND RESULTS Heart failure outpatients attended to establish HF decompensation were included. LUS was blindly performed at baseline (LUS1) and at clinical recompensation (LUS2). B-lines were counted in eight scanned areas. Diagnosis of no HF decompensation vs. right-sided, left-sided, or global HF decompensation, and patients' management were performed by physicians blinded to LUS1. Outcome was the composite of all-cause death or HF-related hospitalization. Two hundred and thirty-three suspicions of HF decompensation were included in 187 patients (71.4 ± 11.3 years, 66.8% men). Mean B-line (LUS1) was 17.6 ± 11.2 vs. 3.7 ± 4.5 for episodes with and without HF decompensation, respectively (P < 0.001). Global HF decompensation showed the highest number of B-lines (20.6 ± 11), followed by left-sided (19.7 ± 11.6) and right-sided (13.5 ± 9.8). B-lines declined to 6.9 ± 6.7 (LUS2) (P < 0.001 vs. LUS1) after treatment, within a mean time of 24.2 ± 23.7 days [median 13.5 days (interquartile range 6-40)]. B-lines were significantly associated with the composite endpoint at 30 days (hazard ratio [HR] 1.04 [95% confidence interval 1.01-1.07], P = 0.02), but not at 60 (P = 0.22) or 180 days (P = 0.54). In multivariable analysis, B-line number remained as an independent predictor of the composite endpoint at 30 days, [HR 1.04 (1.01-1.07), P = 0.014], with a 4% increase risk per B-line added. B-lines correlated significantly with CA125 (R = 0.30, P = 0.001). CONCLUSIONS Lung ultrasound supports the diagnostic work-up of congestion and decongestion in chronic HF outpatients and identifies patients at high risk of short-term events.
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Affiliation(s)
- Mar Domingo
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Josep Lupón
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
- Department of MedicineAutonomous University of BarcelonaBarcelonaSpain
- CIBERCVInstituto de Salud Carlos IIIMadridSpain
| | - Nicolas Girerd
- Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F‐CRIN INI‐CRCTUniversité de LorraineVandoeuvre‐lès‐NancyFrance
| | - Laura Conangla
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Marta de Antonio
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
- CIBERCVInstituto de Salud Carlos IIIMadridSpain
| | - Pedro Moliner
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Evelyn Santiago‐Vacas
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Pau Codina
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - German Cediel
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Giosafat Spitaleri
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Beatriz González
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Violeta Diaz
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Carmen Rivas
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Patricia Velayos
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Julio Núñez
- CIBERCVInstituto de Salud Carlos IIIMadridSpain
- Cardiology DepartmentHospital Clínico Universitario, INCLIVAValènciaSpain
- Department of MedicineUniversitat de ValènciaValènciaSpain
| | - Antoni Bayes‐Genís
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
- Department of MedicineAutonomous University of BarcelonaBarcelonaSpain
- CIBERCVInstituto de Salud Carlos IIIMadridSpain
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25
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Esteban-Fernández A, Carvajal Estupiñan JF, Gavira-Gómez JJ, Pernas S, Moliner P, Garay A, Sánchez-González Á, Fernández-Rozas I, González-Costello J. Clinical Profile and Prognosis of a Real-World Cohort of Patients With Moderate or Severe Cancer Therapy-Induced Cardiac Dysfunction. Front Cardiovasc Med 2021; 8:721080. [PMID: 34778393 PMCID: PMC8585751 DOI: 10.3389/fcvm.2021.721080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/29/2021] [Indexed: 01/19/2023] Open
Abstract
Introduction and Objectives: Cancer therapy-related cardiac dysfunction (CTRCD) is a common cause of cancer treatment withdrawal, related to the poor outcomes. The cardiac-specific treatment could recover the left ventricular ejection fraction (LVEF). We analyzed the clinical profile and prognosis of patients with CTRCD in a real-world scenario. Methods: A retrospective study that include all the cancer patients diagnosed with CTRCD, defined as LVEF < 50%. We analyzed the cardiac and oncologic treatments, the predictors of mortality and LVEF recovery, hospital admission, and the causes of mortality (cardiovascular (CV), non-CV, and cancer-related). Results: We included 113 patients (82.3% women, age 49.2 ± 12.1 years). Breast cancer (72.6%) and anthracyclines (72.6%) were the most frequent cancer and treatment. Meantime to CTRCD was 8 months, with mean LVEF of 39.4 ± 9.2%. At diagnosis, 27.4% of the patients were asymptomatic. Cardiac-specific treatment was started in 66.4% of patients, with LVEF recovery-rate of 54.8%. Higher LVEF at the time of CTRCD, shorter time from cancer treatment to diagnosis of CTRCD, and younger age were the predictors of LVEF recovery. The hospitalization rate was 20.4% (8.8% linked to heart failure). Treatment with trastuzumab and lower LVEF at diagnosis of CTRCD were the predictors of mortality. Thirty point nine percent of patients died during the 26 months follow-up. The non-CV causes and cancer-related were more frequent than CV ones. Conclusions: Cardiac-specific treatment achieves LVEF recovery in more than half of the patients. LVEF at the diagnosis of CTRCD, age, and time from the cancer treatment initiation to CTRCD were the predictors of LVEF recovery. The CV-related deaths were less frequent than the non-CV ones. Trastuzumab treatment and LVEF at the time of CTRCD were the predictors of mortality.
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Affiliation(s)
| | | | | | - Sonia Pernas
- Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia, L'Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Moliner
- Cardiology Department, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alberto Garay
- Cardiology Department, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Álvaro Sánchez-González
- Bladder, Functional and Oncological Pathology Unit, Urology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | | | - José González-Costello
- Cardiology Department, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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26
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Domingo M, Conangla L, Lupón J, de Antonio M, Moliner P, Santiago-Vacas E, Codina P, Zamora E, Cediel G, González B, Díaz V, Rivas C, Velayos P, Santesmases J, Pulido A, Crespo E, Bayés-Genís A. Valor pronóstico de la ecografía de pulmón en pacientes ambulatorios con insuficiencia cardiaca crónica estable. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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27
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Tkaczyszyn M, Comín-Colet J, Voors AA, van Veldhuisen DJ, Enjuanes C, Moliner P, Drozd M, Sierpiński R, Rozentryt P, Nowak J, Suchocki T, Banasiak W, Ponikowski P, van der Meer P, Jankowska EA. Iron deficiency contributes to resistance to endogenous erythropoietin in anaemic heart failure patients. Eur J Heart Fail 2021; 23:1677-1686. [PMID: 34050579 DOI: 10.1002/ejhf.2253] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Received: 01/27/2021] [Revised: 04/22/2021] [Accepted: 05/24/2021] [Indexed: 11/07/2022] Open
Abstract
AIMS Abnormal endogenous erythropoietin (EPO) constitutes an important cause of anaemia in chronic diseases. We analysed the relationships between iron deficiency (ID) and the adequacy of endogenous EPO in anaemic heart failure (HF) patients, and the impact of abnormal EPO on 12-month mortality. METHODS AND RESULTS We investigated 435 anaemic HF patients (age: 74 ± 10 years; males: 60%; New York Heart Association class I or II: 39%; left ventricular ejection fraction: 43 ± 17%). Patients with EPO higher than expected for a given haemoglobin were considered EPO-resistant whereas those with EPO lower than expected - EPO-deficient. ID was defined as serum ferritin <100 µg/L or 100-299 µg/L with transferrin saturation <20%. EPO-resistant patients (22%) had more advanced HF whereas those with EPO deficiency (57%) were more frequently females and had worse renal function. Lower serum ferritin (indicating depleted body iron stores) was related to higher EPO observed/predicted ratio when adjusted for significant clinical confounders, including C-reactive protein. One year all-cause mortality was 28% in patients with EPO resistance compared to 17% in patients with EPO deficiency and 10% in patients with adequate EPO (log-rank test for the comparison EPO resistance vs. adequate EPO: P = 0.02). When adjusted for other prognosticators, there was still a trend towards increased 12-month mortality in patients with higher EPO level. CONCLUSION Anaemic HF patients with endogenous EPO deficiency vs. resistance have different clinical and laboratory characteristics. In such patients, ID contributes to EPO resistance independently of inflammation.
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Affiliation(s)
- Michał Tkaczyszyn
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Josep Comín-Colet
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Community Heart Failure Program, Cardiology Department, University Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cristina Enjuanes
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Community Heart Failure Program, Cardiology Department, University Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Moliner
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Community Heart Failure Program, Cardiology Department, University Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marcin Drozd
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | | | - Piotr Rozentryt
- Silesian Centre for Heart Disease and Silesian Medical University, Zabrze, Poland
| | - Jolanta Nowak
- Silesian Centre for Heart Disease and Silesian Medical University, Zabrze, Poland
| | - Tomasz Suchocki
- Biostatistics Group, Department of Genetics, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Waldemar Banasiak
- Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, University Hospital, Wroclaw, Poland
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28
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Calero-Molina E, Hidalgo E, Rosenfeld L, Verdú-Rotellar JM, Verdú-Soriano J, Garay A, Alcoberro L, Jimenez-Marrero S, Garcimartin P, Yun S, Guerrero C, Moliner P, Delso C, Alcober L, Enjuanes C, Comin-Colet J. The relationship between self-care, long-term mortality, and heart failure hospitalization: insights from a real-world cohort study. Eur J Cardiovasc Nurs 2021; 21:116-126. [PMID: 34008849 DOI: 10.1093/eurjcn/zvab011] [Citation(s) in RCA: 3] [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] [Received: 10/10/2020] [Revised: 12/28/2020] [Accepted: 02/12/2021] [Indexed: 11/12/2022]
Abstract
AIMS The assumption that improved self-care in the setting of heart failure (HF) care necessarily translates into improvements in long-term mortality and/or hospitalization is not well established. We aimed to study the association between self-care and long-term mortality and other major adverse HF events (MAHFE). METHODS AND RESULTS We conducted an observational, prospective, cohort study of 1123 consecutive patients with chronic HF. The primary endpoint was all-cause mortality. We used the European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure global self-care (overall score) and three specific dimensions of self-care including autonomy-based adherence, consulting behaviour and provider-based adherence. After a mean follow-up of 3.3 years, all-cause death occurred in 487 patients (43%). In adjusted analysis, higher EHFScBS-9 scores (better self-care) at baseline were associated with lower risk of all-cause death [hazard ratio (HR) 0.993, 95% confidence interval (CI) (0.988-0.997), P-value = 0.002], cardiovascular (CV) death [HR 0.989, 95% CI (0.981-0.996), P-value = 0.003], HF hospitalization [HR 0.993, 95% CI (0.988-0.998), P-value = 0.005], and the combination of MAHFE [HR 0.995, 95% CI (0.991-0.999), P-value = 0.018]. Similarly, impaired global self-care [HR 1.589, 95% CI (1.201-2.127), P-value = 0.001], impaired autonomy-based adherence [HR 1.464, 95% CI (1.114-1.923), P-value = 0.006], and impaired consulting behaviour dimensions [HR 1.510, 95% CI (1.140-1.923), P-value = 0.006] were all associated with higher risk of all-cause mortality. CONCLUSION In this study, we have shown that worse self-care is an independent predictor of long-term mortality (both, all-cause and CV), HF hospitalization, and the combinations of these endpoints in patients with chronic HF. Important dimensions of self-care such as autonomy-based adherence and consulting behaviour also determine the risk of all these outcomes in the long term.
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Affiliation(s)
- Esther Calero-Molina
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Community Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Encarna Hidalgo
- Cardiology Department, Community Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laia Rosenfeld
- Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Advanced Heart Failure and Heart Transplant Unit, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jose Maria Verdú-Rotellar
- Primary Care Service Litoral, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose Verdú-Soriano
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | - Alberto Garay
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Community Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lidia Alcoberro
- Cardiology Department, Community Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Santiago Jimenez-Marrero
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Community Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paloma Garcimartin
- Head of Advanced Practice Nurses, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.,Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Escuela Superior de Enfermería del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Sergi Yun
- Cardiology Department, Community Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carmen Guerrero
- Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Moliner
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Community Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Delso
- Primary Care Service Delta del Llobregat, Barcelona, Spain
| | - Laia Alcober
- Primary Care Service Delta del Llobregat, Barcelona, Spain
| | - Cristina Enjuanes
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Community Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Comin-Colet
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Community Heart Failure Program, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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Tajes M, Díez-López C, Enjuanes C, Moliner P, Ferreiro JL, Garay A, Jiménez-Marrero S, Yun S, Sosa SG, Alcoberro L, González-Costello J, García-Romero E, Yañez-Bisbe L, Benito B, Comín-Colet J. Neurohormonal activation induces intracellular iron deficiency and mitochondrial dysfunction in cardiac cells. Cell Biosci 2021; 11:89. [PMID: 34001233 PMCID: PMC8130332 DOI: 10.1186/s13578-021-00605-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/06/2021] [Indexed: 12/17/2022] Open
Abstract
Background Iron deficiency (ID) is common in patients with heart failure (HF) and is associated with poor outcomes, yet its role in the pathophysiology of HF is not well-defined. We sought to determine the consequences of HF neurohormonal activation in iron homeostasis and mitochondrial function in cardiac cells. Methods HF was induced in C57BL/6 mice by using isoproterenol osmotic pumps and embryonic rat heart-derived H9c2 cells were subsequently challenged with Angiotensin II and/or Norepinephrine. The expression of several genes and proteins related to intracellular iron metabolism were assessed by Real time-PCR and immunoblotting, respectively. The intracellular iron levels were also determined. Mitochondrial function was analyzed by studying the mitochondrial membrane potential, the accumulation of radical oxygen species (ROS) and the adenosine triphosphate (ATP) production. Results Hearts from isoproterenol-stimulated mice showed a decreased in both mRNA and protein levels of iron regulatory proteins, transferrin receptor 1, ferroportin 1 and hepcidin compared to control mice. Furthermore, mitoferrin 2 and mitochondrial ferritin were also downregulated in the hearts from HF mice. Similar data regarding these key iron regulatory molecules were found in the H9c2 cells challenged with neurohormonal stimuli. Accordingly, a depletion of intracellular iron levels was found in the stimulated cells compared to non-stimulated cells, as well as in the hearts from the isoproterenol-induced HF mice. Finally, neurohormonal activation impaired mitochondrial function as indicated by the accumulation of ROS, the impaired mitochondrial membrane potential and the decrease in the ATP levels in the cardiac cells. Conclusions HF characteristic neurohormonal activation induced changes in the regulation of key molecules involved in iron homeostasis, reduced intracellular iron levels and impaired mitochondrial function. The current results suggest that iron could be involved in the pathophysiology of HF.
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Affiliation(s)
- M Tajes
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - C Díez-López
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Advanced Heart Failure and Heart Transplant Unit, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - C Enjuanes
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - P Moliner
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J L Ferreiro
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - A Garay
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Jiménez-Marrero
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Yun
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - S G Sosa
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - L Alcoberro
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J González-Costello
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Advanced Heart Failure and Heart Transplant Unit, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - E García-Romero
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Advanced Heart Failure and Heart Transplant Unit, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - L Yañez-Bisbe
- Vascular Biology and Metabolism Program, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - B Benito
- Vascular Biology and Metabolism Program, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Cardiology Department, Hospital Vall d'Hebron Hospital, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Comín-Colet
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain. .,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain. .,Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain. .,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
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30
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Jiménez-Marrero S, Cainzos-Achirica M, Monterde D, Vela E, Cleries M, García-Eroles L, Enjuanes C, Yun S, Garay A, Moliner P, Alcoberro L, Corbella X, Comin-Colet J. Impacto clínico y en costes sanitarios de alteraciones de potasio en pacientes con enfermedades cardiovasculares, metabólicas y renales crónicas. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Jimenez S, Cainzos-Achirica M, Monterde D, Garcia-Eroles L, Vela E, Cleries M, Enjuanes C, Yun S, Garay A, Moliner P, Alcoberro L, Calero E, Hidalgo E, Corbella X, Comin-Colet J. 36,269 patients with chronic cardiovascular, metabolic and renal conditions: impact on clinical outcomes, medical resource use and health-related costs of deranged serum potassium levels. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Chronic Heart Failure (CHF) and its risk factors at stage A of the disease are conditions that trends to facilitate potassium (K+) derangements, for pathophysiology mechanisms and medication use than could facilitate both hyper- and hypokalamia. Studies on the associations between potassium derangements and clinical outcomes in these patient populations have yielded mixed findings, and the implications for healthcare expenditure are unknown.
Purpose
The objectives of our analysis was to asses the population-based associations between hyperkalemia, hypokalemia (compared to normokalemia) and all-cause death, urgent hospitalization, emergency department visits, daycare visits, and a yearly healthcare expenditure >85th percentile, in patients with chronic heart failure, chronic kidney disease, diabetes mellitus, hypertension and ischemic heart disease.
Methods
Population-based, longitudinal study including up to 36,269 patients from the Public Healthcare Area with at least one of those conditions. We used three linked administrative, hospital and primary care healthcare databases with exhaustive information on sociodemographics, medical diagnoses, pharmacy dispensing and laboratory data. Participants were identified and followed between 2015 and 2017, had to be ≥55 years old and have at least one serum potassium measurement recorded; and were classified as hyperkalemic, hypokalemic or normokalemic. Four analytic designs were used to evaluate prevalent and incident disease cases as well as prevalent and incident use of renin-angiotensin-aldosterone system inhibitors
Results
The majority of study participants remained normokalemic during the 3 months following study entry (ranging 94%–96%) and hyperkalemia was twice as frequent as hypokalemia. In all analyses, compared to normokalemic patients those with hyperkalemia had a worse crude event-free survival for all endpoints, and the worst survival was observed for hypokalemic patients [see Figure 1: prevalent case analysis; Kaplan-Meier cumulative survivor function curves for all-cause death (upper left), hospitalization (upper right), ED visits (lower left) and daycare visits (lower right)].
In multivariable-adjusted analyses, hyperkalemia was robustly and significantly associated with an increased risk of all-cause death (hazard ratios from Cox regression models ranging 1.31–1.68) and with an increased odds of a yearly healthcare expenditure >85th percentile (odds ratios 1.21–1.29). Associations were even stronger in hypokalemic patients (hazard ratios for all-cause death 1.92–2.60; odds ratios for healthcare expenditure >percentile 85th 1.81–1.85).
Conclusions
Experimental studies are needed to confirm whether prevention of potassium derangements reduces mortality and healthcare expenditure in patients with these chronic conditions. Until then, our findings provide further observational evidence on the potential importance of maintaining normal potassium levels in this setting.
Figure 1
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The present study was funded by an unrestricted research grant from Vifor Pharma.
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Affiliation(s)
- S Jimenez
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - M Cainzos-Achirica
- Johns Hopkins University of Baltimore, Baltimore, United States of America
| | | | | | - E Vela
- Department of Health, Barcelona, Spain
| | - M Cleries
- Department of Health, Barcelona, Spain
| | - C Enjuanes
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - S Yun
- University Hospital of Bellvitge, Internal Medicine, Barcelona, Spain
| | - A Garay
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - P Moliner
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - L Alcoberro
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - E Calero
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - E Hidalgo
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - X Corbella
- University Hospital of Bellvitge, Internal Medicine, Barcelona, Spain
| | - J Comin-Colet
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
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Alcoberro L, Vime J, Enjuanes C, Jimenez S, Garay A, Yun S, Moliner P, Guerrero C, Hidalgo E, Calero E, Marin R, Alcober L, Delso C, Comin J. Double check discharge planning to improve the results of a heart failure programme. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Reduction of readmissions in heart failure (HF) patients is a main goal of HF programmes. Establishing a discharge planning for the patient and coordinating it with primary care teams are key aspects for their success.
Purpose
Evaluate whether a double check discharge planning based on adding face-to-face joint weekly sessions with primary care managers to the conventional electronic communication of care plan reduces 6-month readmission and 6-month mortality.
Methods
We evaluated all patients discharged from hospital with HF as primary diagnosis between September 2017 and January 2019. We compared outcomes between patients discharged during Period #1 (single check; September 2017 - April 2018) and those discharged during Period #2 (double check; May 2018 - January 2019).
Primary endpoint was the combined endpoint of all-cause death or all-cause hospitalization 6 months after discharge from the index hospitalization.
Results
The study enrolled 317 patients: 182 in Period #1 and 135 in Period #2.
Mean age was 76±9 years. There was a higher proportion of patients with diabetes and COPD in Period #1, with no differences in other baseline characteristics.
The combined endpoint of all cause-death and all-cause hospitalization at 6 months was significantly reduced in patients in the double check discharge planning group (27% vs. 16%, p 0.021).
Conclusions
In a HF programme, the addition of a double check discharge planning based on having joint weekly sessions with primary care managers on top of the conventional electronic communication of care plan reduces 6-month readmission and 6-month mortality.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Hospital Universitari de Bellvitge
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Affiliation(s)
- L Alcoberro
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - J Vime
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - C Enjuanes
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - S Jimenez
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - A Garay
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - S Yun
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - P Moliner
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - C Guerrero
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - E Hidalgo
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - E Calero
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - R Marin
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - L Alcober
- Delta Primary Care Service, ICS, Hospitalet de Llobregat, Spain
| | - C Delso
- Delta Primary Care Service, ICS, Hospitalet de Llobregat, Spain
| | - J Comin
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
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Jimenez-Marrero S, Moliner P, Rodríguez-Costoya I, Enjuanes C, Alcoberro L, Yun S, Gonzalez-Costello J, Garay A, Tajes M, Calero E, Hidalgo E, Guerrero C, García-Romero E, Díez-López C, Cainzos-Achirica M, Comin-Colet J. Sympathetic activation and outcomes in chronic heart failure: Does the neurohormonal hypothesis apply to mid-range and preserved ejection fraction patients? Eur J Intern Med 2020; 81:60-66. [PMID: 32718877 DOI: 10.1016/j.ejim.2020.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/28/2020] [Accepted: 07/07/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Sympathetic activity (SA) is increased in patients with heart failure and reduced ejection fraction (HFrEF) and is associated with poor outcomes. However, its clinical implications are less understood in HF with mid-range (HFmrEF) and preserved ejection fraction (HFpEF). We aimed to study SA across left ventricle ejection fraction (LVEF) groups and its association with clinical outcomes. METHODS AND RESULTS SA estimated by norepinephrine (NE) levels was determined in 742 consecutive outpatients with chronic HF: 348 (47%) with HFrEF, 116 (16%) HFmrEF, and 278 (37%) HFpEF. After a mean follow-up of 15 months, 17% died. Adjusted analyses showed that patients with HFpEF and HFmrEF had lower estimated marginal means of NE levels compared to HFrEF (278 and 116 pg/mL, respectively, vs. 348 pg/mL; p-value=0.005). Adjusted Cox regression analyses showed that high norepinephrine levels independently predicted all-cause mortality (ACM) in all 3 groups. The strongest associations between high NE levels and cardiovascular mortality (CVM) were observed in HFmrEF (HR: 4.7 [1.33-16.68]), while the weakest association was in HFpEF (HR: 2.62 [1.08-6.35]). CONCLUSIONS Adjusted analyses showed that HFpEF and HFmrEF were associated with lower SA compared to HFrEF. Nevertheless, increasing NE levels were independently associated with ACM and CVM in all three LVEF groups. The strongest association between high NE levels and CVM was present in HFmrEF patients, while the weakest was seen in HFpEF. These findings could explain why the response to neurohormonal therapies in patients with HFmrEF is similar to that of patients with HFrEF rather than with HFpEF.
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Affiliation(s)
- Santiago Jimenez-Marrero
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Cardio-Oncology Unit, Cardiology Department, Bellvitge University Hospital-Catalan Institute of Oncology (ICO), L'Hospital de Llobregat, Barcelona, Spain
| | - Pedro Moliner
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Cardio-Oncology Unit, Cardiology Department, Bellvitge University Hospital-Catalan Institute of Oncology (ICO), L'Hospital de Llobregat, Barcelona, Spain.
| | - Iris Rodríguez-Costoya
- Department of Cardiology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Heart Diseases Biomedical Research Group, Research Programme in Inflammatory and Cardiovascular Disorders, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Cristina Enjuanes
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lidia Alcoberro
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Cardio-Oncology Unit, Cardiology Department, Bellvitge University Hospital-Catalan Institute of Oncology (ICO), L'Hospital de Llobregat, Barcelona, Spain
| | - Sergi Yun
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Internal Medicine, Bellvitge University Hospital, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Jose Gonzalez-Costello
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Advanced Heart Failure and Heart Transplant Unit, Department ion Cardiology, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Alberto Garay
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Cardio-Oncology Unit, Cardiology Department, Bellvitge University Hospital-Catalan Institute of Oncology (ICO), L'Hospital de Llobregat, Barcelona, Spain
| | - Marta Tajes
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Esther Calero
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Encarnación Hidalgo
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carmen Guerrero
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elena García-Romero
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Advanced Heart Failure and Heart Transplant Unit, Department ion Cardiology, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Carles Díez-López
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Advanced Heart Failure and Heart Transplant Unit, Department ion Cardiology, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Miguel Cainzos-Achirica
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore MD, United States; Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist Hospital, Houston TX, United States
| | - Josep Comin-Colet
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
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Guerrero G, Alcoberro L, Vime J, Calero E, Hidalgo E, Marin R, Enjuanes C, Garay A, Yun S, Jimenez S, Moliner P, Delso C, Fernandez I, Rosenfeld L, Comin J. Effectiveness of nurse-led hospital-based heart failure programmes in octagenarians and nonagenarians: is age important? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Efficacy of HF programmes in oldest old (octogenarians and nonagenarians) has not been fully explored.
Methods
We conducted a natural experiment evaluating all patients after hospitalization for heart failure as primary diagnosis between January 2017 and January 2019. We compared outcomes between patients discharged during Period #1, before the implementation of the program with patients discharged during Period #2, after the implementation of the 7-step bundle of interventions. We explored the interaction between age group (<80 vs. ≥80 years old) by the intervention modality (HF programme vs. usual care). Primary end-point was the combined end-point of all-cause death or all-cause hospitalization at 6 months after discharge from the index hospitalization.
Results
The study enroled 440 patients. Mean age of the whole cohort was 75±9 years. In the oldest old subgroup (n=160), mean age was 84±3. No differences were found in baseline characteristics of patients between usual care and HF program. 30-day all-cause readmission was significantly reduced in patients in the HF programme group compared to patients in the usual care group in both age strata. In unadjusted Cox regression analyses in the oldest old group, management of patients in the HF programme was significanty associated with a reduction in the risk of the primary end-point (HR: 0.50; 95% CI [0.29–0.85]; p=0.011).
Conclusions
Management of patients in a nurse-led integrated care-based heart failure programme results in reduction of all-cause death or all-cause hospitalizations in oldest old patients.
Event-free survival cumulative curves.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G Guerrero
- University Hospital Bellvitge, Barcelona, Spain
| | - L Alcoberro
- University Hospital Bellvitge, Barcelona, Spain
| | - J Vime
- University Hospital Bellvitge, Barcelona, Spain
| | - E Calero
- University Hospital Bellvitge, Barcelona, Spain
| | - E Hidalgo
- University Hospital Bellvitge, Barcelona, Spain
| | - R Marin
- University Hospital Bellvitge, Barcelona, Spain
| | - C Enjuanes
- University Hospital Bellvitge, Barcelona, Spain
| | - A Garay
- University Hospital Bellvitge, Barcelona, Spain
| | - S Yun
- University Hospital Bellvitge, Barcelona, Spain
| | - S Jimenez
- University Hospital Bellvitge, Barcelona, Spain
| | - P Moliner
- University Hospital Bellvitge, Barcelona, Spain
| | - C Delso
- University Hospital Bellvitge, Barcelona, Spain
| | - I Fernandez
- University Hospital Bellvitge, Barcelona, Spain
| | - L Rosenfeld
- University Hospital Bellvitge, Barcelona, Spain
| | - J Comin
- University Hospital Bellvitge, Barcelona, Spain
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Jimenez S, Cainzos-Achirica M, Monterde D, Garcia-Eroles L, Enjuanes C, Garay A, Yun S, Moliner P, Alcoberro L, Calero E, Hidalgo E, Marin R, Corbella X, Comin-Colet J. Epidemiology of potassium derangements among chronic cardiovascular, metabolic and renal conditions: a population-based analysis data from more than 375,000 individuals. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In patients with chronic cardiovascular, metabolic and renal disorders, potassium (K)+ homeostasis is often delicate, especially in the presence of renin-angiotensin-aldosterone system inhibition (RAASI) and/or diuretic therapies. In this context, current clinical practical guidelines for the management of these patients recommend close monitoring of renal function and K+ levels, particularly in the presence of drug titration. Nevertheless, very limited epidemiological data on their importance at a population level is available.
Purpose
The objectives of the present analysis are to estimate the prevalence of potassium (K+) derangements in five key chronic cardiovascular, metabolic and renal conditions at the population level, its use of RAASI medication and describe potassium derangements among RAASI users.
Methods
We used data from more than 375,000 individuals 55 years of age or older included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. The conditions of interest were chronic heart failure (CHF), chronic kidney disease (CKD), diabetes mellitus (DM), ischemic heart disease (IHD), and hypertension (HTN). RAASI medications included angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor antagonists (MRAs), and rennin inhibitors. Hyperkalemia was defined as K+ levels >5.0 mEq/L and hypokalemia as K+ <3.5 mEq /L
Results
The prevalence of chronic cardiovascular, metabolic and renal conditions was high, particularly of HTN (48.2–48.9%). The prevalence of hyperkalemia was ranging between 10% and 25% depending of the condition, more frequent in CKD and less frequent in HTN patients. In figure, we display the prevalence of hyperkalemia among individuals with each of the relevant chronic conditions, January 1st, 2016 and January 1st, 2017. Use of at least one RAASI medication was very prevalent in HTN patients (75.2–77.3%). Among RAASI users, the frequency of K+ derangements and mainly of hyperkalemia was very noticeable (12% overall), especially in patients with CKD, CHF, elderly individuals, and users of MRAs. Hypokalemia was less frequent (1%).
Conclusion
The high prevalence of K+ derangements and predominantly hyperkalemia among RAASI users highlights the real-world relevance of K+ derangements and the importance of close monitoring and management of K+ levels in routine clinical practice. This is likely to benefit a large number of patients, particularly those at higher risk.
Figure 1. Prevalence of hyperkalemia
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Josep Comin-Colet and Miguel Cainzos-Achirica have participated in other research projects funded by unrestricted grants from Vifor Pharma
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Affiliation(s)
- S Jimenez
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - M Cainzos-Achirica
- Johns Hopkins University of Baltimore, Baltimore, United States of America
| | | | | | - C Enjuanes
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - A Garay
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - S Yun
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - P Moliner
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - L Alcoberro
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - E Calero
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - E Hidalgo
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - R Marin
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - X Corbella
- University Hospital of Bellvitge, Internal Medicine, Barcelona, Spain
| | - J Comin-Colet
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
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Calero E, Hidalgo E, Rosenfeld L, Fernandez I, Garay A, Alcoberro L, Jimenez S, Yun S, Guerrero C, Moliner P, Delso C, Alcober L, Enjuanes C, Comin-Colet J. Psychosocial and clinical factors associated with poor self-care in patients with chronic heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Self care is a crucial factor in the education of patients with heart failure (HF) and directly impacts in the progression of the disease.
Beyond heart failure related factors, the role of psychosocial determinants and its interaction with clinical aspects has not been fully explored.
Aims
The aim of the study was to analyze both clinical and psychosocial factors associated with poor self care in patients with chronic HF.
Methods
Self care was evaluated at baseline with the 9 item European HFR Self Care Behaviour Scale (9 item ESCBS).
Scores were standardized and reversed from 0 (worst self care) to 100 (better self care). This study we analysed the associations between poor self care (defined as scores in the lower tertile of the 9 item ESCBS) with demographic, HF-related (clinical) and psychosocial factors in all patients at baseline.
Results
We included 1123 patients: mean age 72±11, 639 (60%) were male, mean LVEF 45±17 and 454 (40%) were in NYHA class III or IV. Mean score of the 9-item ESCBS was 69±28. In the clinical multivariate analyses HF-related factors associated with poor self-care were serum albumins level, ckd level and previous admission due to heart failure. In the psychosocial multivariate analyses poor social support, depressive symptoms and needing a caregiver were independently associated with poor self care. In combined models, only psychosocial factors were independently associated with poor self care whereas no clinical factors remain in the model.
Conclusion
Our study showed that psychosocial conditions are the main factors independently associated with poor self-care in patients with chronic heart failure
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Hospital del Bellvitge
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Affiliation(s)
- E Calero
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - E Hidalgo
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - L Rosenfeld
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - I Fernandez
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Garay
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - L Alcoberro
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - S Jimenez
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - S Yun
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - C Guerrero
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - P Moliner
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - C Delso
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - L Alcober
- Primary Care Centre Just Oliveres, Hospitalet De Llobregat, Spain
| | - C Enjuanes
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J Comin-Colet
- Hospital Universitari de Bellvitge, Barcelona, Spain
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Calero E, Hidalgo E, Marin R, Rosenfeld L, Fernandez I, Garay A, Alcoberro L, Jimenez S, Yun S, Guerrero C, Moliner P, Delso C, Alcober L, Enjuanes C, Comin-Colet J. Association between self-care and prognosis in 1123 patients with chronic heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Self-care is a crucial factor in the education of patients with heart failure (HF) and directly impacts in the progression of the disease. However, little is published about its major clinical implications as admission or mortality in patients with HF.
Aims and methods
The aim of the study was to analyze time to admission due to acute heart failure and mortality associated with poor self-care in patients with chronic HF.
We prospectively recruited consecutive patients with stable chronic HF referred to a nurse-led HF programme. Selfcare was evaluated at baseline with the 9 item European Heart Failure Self-Care Behavior Scale. Scores were standardized and reversed from 0 (worst selfcare) to 100 (better self care). For the purpose of this study we analyzed the associations of worse self-care (defined as scores below the lower tertile of the scale) with demographic, disease-related (clinical) and psychosocial factors in all patients at baseline.
Results
We included 1123 patients, mean age 72±11, 639 (60%) were male, mean LVEF 45±17 and 454 (40,4%) were in NYHA class III or IV. Mean score of the 9-item ESCBE was 69±28. Score below 55 (lower tertile) defined impaired selfcare behaviour.
Those patients with worse self-care had more ischaemic heart disease, more COPD, and they achieved less distance in the 6 minute walking test. Regarding psychosocial items patients in lower tertile of self-care needed a caregiver more frequently, they present more cognitive impairment, depressive symptoms and worse score in terms of health self-perception.
Multivariate Cox Models showed that a score below 55 points in 9-item ESCBE was independently associated with higher readmission due to acute heart failure [HR 1.26 (1.02–1.57), p value=0.034] and with mortality [HR 1.24 CI95% (1.02–1.50), p value=0.028]
Conclusion
Poor self-care measured with the modified 9-item ESCBE was associated with higher risk of admission due to acute decompensation and higher risk of mortality in patients with chronic heart failure.
These results highlight the importance of assessing self-care and provide measures to improve them.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Hospital Univesitario de Bellvitge
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Affiliation(s)
- E Calero
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - E Hidalgo
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - R Marin
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - L Rosenfeld
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - I Fernandez
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Garay
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - L Alcoberro
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - S Jimenez
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - S Yun
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - C Guerrero
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - P Moliner
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - C Delso
- Institut Catala de la Salut, Barcelona, Spain
| | - L Alcober
- Primary Care Centre Just Oliveres, Hospitalet De Llobregat, Spain
| | - C Enjuanes
- Primary Care Centre Just Oliveres, Hospitalet De Llobregat, Spain
| | - J Comin-Colet
- Primary Care Centre Just Oliveres, Hospitalet De Llobregat, Spain
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Jimenez S, Cainzos-Achirica M, Monterde D, Garcia-Eroles L, Enjuanes C, Garay A, Yun S, Alcoberro L, Moliner P, Hidalgo E, Calero E, Marin R, Corbella X, Comin-Colet J. A population-based analysis in 375,233 cases of heart failure stages A, B and C. Real world epidemiology of prevalence and temporal trends in South-European populations. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Prevalence of congestive heart failure (CHF) and predisposing conditions has described previously. Most of these studies evaluated centre-European or north-American populations. However, the prevalence and evolutionary changes of Heart Failure stages A, B and C has not been fully elucidated in Mediterranean cohorts.
Purpose
To estimate the prevalence of CHF (HF Stage C) and four additional key chronic cardiovascular, metabolic and renal conditions predisposing to the development of CHF (HF Stages A and B) at a population level in a south-European healthcare area. We analysed the evolutionary changes in the prevalence in these five conditions.
Methods
In a healthcare area of 1,3Millions inhabitants, we extracted health related information of all individuals ≥55 years old. We analysed data of 375,233 individuals included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. The conditions of interest were CHF, chronic kidney disease (CKD), diabetes mellitus (DM), ischemic heart disease (IHD) and hypertension (HTN).
Results
The prevalence of chronic conditions was high, particularly of HTN (48.2–48.9%) and DM individuals (14.6–14.8%). The other conditions were less frequent, with prevalence around 2–4% for IHD, 5–9% for CKD and 2–4% for CHF (Table). However, the less frequent conditions had a striking upward trend with over 1,500 new prevalent cases per year between 2015 and 2017 for CHF (45% relative increase), more than 2,500 new prevalent cases for IHD (67% relative increase) and more than 4,000 new prevalent cases per year for CKD (44% relative increase).
Conclusion
In this south European cohort, there were a high prevalence of HTN and DM as risk factors and a significant trend of increasing prevalence in high cost chronic conditions such as CHF, IHD and CKD.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): The present study was funded by an unrestricted research grant from Vifor Pharma.
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Affiliation(s)
- S Jimenez
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - M Cainzos-Achirica
- Johns Hopkins University of Baltimore, Baltimore, United States of America
| | | | | | - C Enjuanes
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - A Garay
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - S Yun
- University Hospital of Bellvitge, Internal Medicine, Barcelona, Spain
| | - L Alcoberro
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - P Moliner
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - E Hidalgo
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - E Calero
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - R Marin
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - X Corbella
- University Hospital of Bellvitge, Internal Medicine, Barcelona, Spain
| | - J Comin-Colet
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
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Alcoberro L, Vime J, Enjuanes C, Jimenez S, Garay A, Yun S, Moliner P, Guerrero C, Hidalgo C, Calero E, Marin R, Alcober L, Delso C, Comin J. Long-term effectiveness of a nurse-led 7-step transitional intervention programme in heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Reduction of 30-day readmission in heart failure (HF) patients is a main goal of health-care systems. Programmes to decrease 30-day readmission have successfully reduced it but have failed to neither maintain benefit afterwards nor decrease mortality. Moreover, in many cases the price of reducing 30-day readmission is a mortality increase.
Purpose
Evaluate whether the impact of a fully nurse-led HF programme directed to reduce 30-day readmission and mortality extends to longer periods of time, including 90 days and 180 days after discharge.
Methods
We evaluated all patients discharged from hospital with HF as primary diagnosis between January 2017 and January 2019. We compared outcomes between patients discharged during Period #1 (pre-programme; Jan 2017 - Aug 2017) and those discharged during Period #2 (HF programme; Sept 2017 - Jan 2019).
Primary endpoint was the combined endpoint of all-cause death or all-cause hospitalization 90 days and 180 days after discharge from the index hospitalization.
Results
The study enrolled 440 patients: 123 in Period #1 and 317 in Period #2.
Mean age was 75±9 years. There was a higher proportion of female patients in Period #2 (38.2% vs 26.8%, p=0.025), with no differences in other baseline characteristics.
The combined endpoint of all cause-death and all-cause hospitalization was significantly reduced in patients in the HF programme group, both at 90 days [OR 0.37 (0.22–0.63), p<0.001] and at 180 days [OR 0.27 (CI 0.17–0.43), p<0.001]. Such a decrease was at expense of a reduction in cardiovascular (CV) hospitalization and HF hospitalization.
There were no differences between groups in mortality [OR 0.96 (0.18–5.00), p=0.293].
Conclusions
A fully nurse-led HF programme reduces the combined endpoint of all-cause death and all-cause hospitalization both at 90 days and 180 days after an index discharge for HF.
Such a decrease is driven by a reduction of CV and HF hospitalization, which are maintained over time. There were no differences between groups in mortality.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Hospital Universitari de Bellvitge
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Affiliation(s)
- L Alcoberro
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - J Vime
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - C Enjuanes
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - S Jimenez
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - A Garay
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - S Yun
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - P Moliner
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - C Guerrero
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - C Hidalgo
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - E Calero
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - R Marin
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - L Alcober
- Delta Primary Care Service, ICS, Hospitalet de Llobregat, Spain
| | - C Delso
- Delta Primary Care Service, ICS, Hospitalet de Llobregat, Spain
| | - J Comin
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
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Yun S, Enjuanes C, Calero E, Hidalgo E, Cobo M, Llàcer P, García-Pinilla JM, González-Franco Á, Núñez J, Morales-Rull JL, Beltrán P, Delso C, Freixa-Pamias R, Moliner P, Corbella X, Comín-Colet J. Study design of Heart failure Events reduction with Remote Monitoring and eHealth Support (HERMeS). ESC Heart Fail 2020; 7:4448-4457. [PMID: 32940428 PMCID: PMC7754948 DOI: 10.1002/ehf2.12962] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/17/2020] [Accepted: 07/30/2020] [Indexed: 01/10/2023] Open
Abstract
AIMS The role of non-invasive telemedicine (TM) combining telemonitoring and teleintervention by videoconference (VC) in patients recently admitted due to heart failure (HF) ('vulnerable phase' HF patients) is not well established. The aim of the Heart failure Events reduction with Remote Monitoring and eHealth Support (HERMeS) trial is to assess the impact on clinical outcomes of implementing a TM service based on mobile health (mHealth), which includes remote daily monitoring of biometric data and symptom reporting (telemonitoring) combined with VC structured, nurse-based follow-up (teleintervention). The results will be compared with those of the comprehensive HF usual care (UC) strategy based on face-to-face on-site visits at the vulnerable post-discharge phase. METHODS AND RESULTS We designed a 24 week nationwide, multicentre, randomized, controlled, open-label, blinded endpoint adjudication trial to assess the effect on cardiovascular (CV) mortality and non-fatal HF events of a TM-based comprehensive management programme, based on mHealth, for patients with chronic HF. Approximately 508 patients with a recent hospital admission due to HF decompensation will be randomized (1:1) to either structured follow-up based on face-to-face appointments (UC group) or the delivery of health care using TM. The primary outcome will be a composite of death from CV causes or non-fatal HF events (first and recurrent) at the end of a 6 month follow-up period. Key secondary endpoints will include components of the primary event analysis, recurrent event analysis, and patient-reported outcomes. CONCLUSIONS The HERMeS trial will assess the efficacy of a TM-based follow-up strategy for real-world 'vulnerable phase' HF patients combining telemonitoring and teleintervention.
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Affiliation(s)
- Sergi Yun
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Enjuanes
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Esther Calero
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Encarnación Hidalgo
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Cobo
- Department of Cardiology, Puerta de Hierro Majadahonda University Hospital, Puerta de Hierro-Segovia de Arana Health Research Institute (IDIPHSA), Madrid, Spain.,Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Pau Llàcer
- Department of Internal Medicine, Manises Hospital, Medical Research Institute of Hospital La Fe (IIS La Fe), València, Spain
| | - José Manuel García-Pinilla
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Carlos III Health Institute (ISCIII), Madrid, Spain.,Department of Cardiology, Heart Failure and Familial Cardiomyopathy Unit, Virgen de la Victoria University Hospital (HUVV), Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain
| | - Álvaro González-Franco
- Department of Internal Medicine, Central de Asturias University Hospital (HUCA), Foundation for Health and Biomedicine Research and Innovation of Asturias (FINBA), Oviedo, Spain
| | - Julio Núñez
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Carlos III Health Institute (ISCIII), Madrid, Spain.,Department of Cardiology, Clinic of València University Hospital, Biomedical Research Institute of València (INCLIVA), School of Medicine, University of València, València, Spain
| | - José Luis Morales-Rull
- Department of Internal Medicine, Heart Failure Unit, Arnau de Vilanova University Hospital, Lleida Biomedical Research Institute's Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
| | - Paola Beltrán
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Cardiology, Viladecans Hospital, Institut Català de la Salut (ICS), Viladecans, Barcelona, Spain
| | - Cristina Delso
- Chronic Care Teams, Primary Care Service (SAP) Delta Llobregat, Foundation University Institute for Research in Primary Health Care Jordi Gol i Gurina (IDIAPJGol), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Román Freixa-Pamias
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Cardiology, Sant Joan Despí Moisès Broggi Hospital, Consorci Sanitari Integral (CSI), Department of Clinical Sciences, School of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Pedro Moliner
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Hestia Chair in Integrated Health and Social Care, School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Josep Comín-Colet
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona (UB), Barcelona, Spain
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Jiménez-Marrero S, Cainzos-Achirica M, Monterde D, Garcia-Eroles L, Enjuanes C, Yun S, Garay A, Moliner P, Alcoberro L, Corbella X, Comin-Colet J. Real-World Epidemiology of Potassium Derangements Among Chronic Cardiovascular, Metabolic and Renal Conditions: A Population-Based Analysis. Clin Epidemiol 2020; 12:941-952. [PMID: 32982459 PMCID: PMC7494006 DOI: 10.2147/clep.s253745] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aims of the present analysis are to estimate the prevalence of five key chronic cardiovascular, metabolic and renal conditions at the population level, the prevalence of renin-angiotensin-aldosterone system inhibitor (RAASI) medication use and the magnitude of potassium (K+) derangements among RAASI users. METHODS AND RESULTS We used data from more than 375,000 individuals, 55 years of age or older, included in the population-based healthcare database of the Catalan Institute of Health between 2015 and 2017. The conditions of interest were chronic heart failure (CHF), chronic kidney disease (CKD), diabetes mellitus, ischemic heart disease and hypertension. RAASI medications included angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor antagonists (MRAs) and renin inhibitors. Hyperkalemia was defined as K+ levels >5.0 mEq/L and hypokalemia as K+ <3.5 mEq/L. The prevalence of chronic cardiovascular, metabolic and renal conditions was high, and particularly that of hypertension (prevalence ranging from 48.2% to 48.9%). The use of at least one RAASI medication was almost ubiquitous in these patients (75.2-77.3%). Among RAASI users, the frequency of K+ derangements, mainly of hyperkalemia, was very noticeable (12% overall), particularly in patients with CKD or CHF, elderly individuals and users of MRAs. Hypokalemia was less frequent (1%). CONCLUSION The high prevalence of K+ derangements, and particularly hyperkalemia, among RAASI users highlights the real-world relevance of K+ derangements, and the importance of close monitoring and management of K+ levels in routine clinical practice. This is likely to benefit a large number of patients, particularly those at higher risk.
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Affiliation(s)
- Santiago Jiménez-Marrero
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Miguel Cainzos-Achirica
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- School of Medicine and Health Sciences, International University of Catalonia, Barcelona, Spain
| | - David Monterde
- Healthcare Information and Knowledge Unit, Catalan Health Service, Barcelona, Spain
| | - Luis Garcia-Eroles
- Healthcare Information and Knowledge Unit, Catalan Health Service, Barcelona, Spain
| | - Cristina Enjuanes
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Yun
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Internal Medicine, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Alberto Garay
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Moliner
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Lidia Alcoberro
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Internal Medicine, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Hestia Chair in Integrated Health and Social Care, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Josep Comin-Colet
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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Moliner P, Lupón J. Tendencies in cause of death in patients with chronic heart failure and depressed systolic function. Rev Esp Cardiol (Engl Ed) 2020; 73:783-784. [PMID: 32631798 DOI: 10.1016/j.rec.2020.03.027] [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: 02/28/2020] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Pedro Moliner
- Unidad Multidisciplinaria de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Lupón
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Instituto de Salud Carlos III, CIBERCV, Madrid, Spain.
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Domingo M, Conangla L, Lupón J, de Antonio M, Moliner P, Santiago-Vacas E, Codina P, Zamora E, Cediel G, González B, Díaz V, Rivas C, Velayos P, Santesmases J, Pulido A, Crespo E, Bayés-Genís A. Prognostic value of lung ultrasound in chronic stable ambulatory heart failure patients. Rev Esp Cardiol (Engl Ed) 2020; 74:862-869. [PMID: 32861606 DOI: 10.1016/j.rec.2020.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/13/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES The role of lung ultrasound (LUS) in acute heart failure (HF) has been widely studied, but little is known about its usefulness in chronic HF. This study assessed the prognostic value of LUS in a cohort of chronic HF stable ambulatory patients. METHODS We included consecutive outpatients who attended a scheduled follow-up visit in a HF clinic. LUS was performed in situ. The operators were blinded to clinical data and examined 8 thoracic areas. The sum of B-lines across all lung zones and the quartiles of this addition were used for the analyses. Linear regression and Cox regression analyses were performed. The main clinical outcomes were a composite of all-cause death or hospitalization for HF and mortality from any cause. RESULTS A total of 577 individuals were included (72% men; 69± 12 years). The mean number of B-lines was 5±6. During a mean follow-up of 31±7 months, 157 patients experienced the main clinical outcome and 111 died. Having ≥ 8 B-lines (Q4) doubled the risk of experiencing the composite primary event (P <.001) and increased the risk of death from any cause by 2.6-fold (P <.001). On multivariate analysis, the total sum of B-lines remained independent predictive factor of the composite endpoint (HR, 1.04; 95%CI, 1.02-1.06; P=.002) and of all-cause death (HR, 1.04; 95%CI, 1.02-1.07; P=.001), independently of whether or not N-terminal pro-B-type natriuretic peptide (NT-proBNP) was included in the model (P=.01 and P=.008, respectively), with a 3% to 4% increased risk for each 1-line addition. CONCLUSIONS LUS identified patients with stable chronic HF at high risk of death or HF hospitalization.
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Affiliation(s)
- Mar Domingo
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Laura Conangla
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep Lupón
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta de Antonio
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro Moliner
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Evelyn Santiago-Vacas
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Pau Codina
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elisabet Zamora
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Germán Cediel
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Beatriz González
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Violeta Díaz
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Carmen Rivas
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Patricia Velayos
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Javier Santesmases
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ana Pulido
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Eva Crespo
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.
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Garay A, Tapia J, Anguita M, Formiga F, Almenar L, Crespo-Leiro MG, Manzano L, Muñiz J, Chaves J, De Frutos T, Moliner P, Corbella X, Enjuanes-Grau C, Comín-Colet J. Gender Differences in Health-Related Quality of Life in Patients with Systolic Heart Failure: Results of the VIDA Multicenter Study. J Clin Med 2020; 9:jcm9092825. [PMID: 32878281 PMCID: PMC7563299 DOI: 10.3390/jcm9092825] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/30/2022] Open
Abstract
Previous studies have shown that heart failure is associated with worse health-related quality of life (HRQoL). The existence of differences according to gender remains controversial. We studied 1028 consecutive outpatients with heart failure and reduced ejection fraction (HFrEF) from a multicentre cross-sectional descriptive study across Spain that assessed HRQoL using two questionnaires (KCCQ, Kansas City Cardiomyopathy Questionnaire; and EQ-5D, EuroQoL 5 dimensions). The primary objective of the study was to describe differences in HRQoL between men and women in global scores and domains of health status of patients and explore gender differences and its interactions with heart failure related factors. In adjusted analysis women had lower scores in KCCQ overall summary scores when compared to men denoting worse HRQoL (54.7 ± 1.3 vs. 62.7 ± 0.8, p < 0.0001), and specifically got lower score in domains of symptom frequency, symptoms burden, physical limitation, quality of life and social limitation. No differences were found in domains of symptom stability and self-efficacy. Women also had lower scores on all items of EQ-5D (EQ-5D index 0.58 ± 0.01 vs. 0.67 ± 0.01, p < 0.0001). Finally, we analyzed interaction between gender and different clinical determinants regarding the presence of limitations in the 5Q-5D and overall summary score of KCCQ. Interestingly, there was no statistical significance for interaction for any variable. In conclusion, women with HFrEF have worse HRQoL compared to men. These differences do not appear to be mediated by clinical or biological factors classically associated with HRQoL nor with heart failure severity.
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Affiliation(s)
- Alberto Garay
- Unidad de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (P.M.); (C.E.-G.)
- Programa Territorial de Atención Integrada a la Insuficiencia Cardiaca Comunitaria de la Gerencia Metropolitana Sur del Instituto Catalán de la Salud, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Unidad de Cardio-Oncología Hospital de Bellvitge–Instituto Catalán de Oncología, L’Hospitalet del Llobregat, 08907 Barcelona, Spain
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Javier Tapia
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
- Departamento de Ciencias Clínicas, Universidad de Barcelona, 08907 Barcelona, Spain
| | - Manuel Anguita
- Unidad de Insuficiencia Cardíaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba 14004, Argentina;
| | - Francesc Formiga
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge, l’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.F.); (X.C.)
| | - Luis Almenar
- Unidad de Insuficiencia Cardíaca y Trasplante, Servicio de Cardiología, Hospital Universitario La Fe, 46009 Valencia, Spain;
| | - María G. Crespo-Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña (UDC), 15006 A Coruña, Spain;
| | - Luis Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, 28034 Madrid, Spain;
| | - Javier Muñiz
- Instituto Universitario de Ciencias de la Salud, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, 15006 La Coruña, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 15705 Santiago de Compostela, Spain
| | - José Chaves
- Medical Department, Internal Medicine, Pfizer Biopharmaceuticals Group, 28108 Alcobendas, Spain; (J.C.); (T.D.F.)
| | - Trinidad De Frutos
- Medical Department, Internal Medicine, Pfizer Biopharmaceuticals Group, 28108 Alcobendas, Spain; (J.C.); (T.D.F.)
| | - Pedro Moliner
- Unidad de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (P.M.); (C.E.-G.)
- Programa Territorial de Atención Integrada a la Insuficiencia Cardiaca Comunitaria de la Gerencia Metropolitana Sur del Instituto Catalán de la Salud, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Unidad de Cardio-Oncología Hospital de Bellvitge–Instituto Catalán de Oncología, L’Hospitalet del Llobregat, 08907 Barcelona, Spain
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Xavier Corbella
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge, l’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.F.); (X.C.)
- Cátedra HESTIA en Atención Integrada Social y Sanitaria, Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Sant Cugat del Vallès, 08017 Barcelona, Spain
| | - Cristina Enjuanes-Grau
- Unidad de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (P.M.); (C.E.-G.)
- Programa Territorial de Atención Integrada a la Insuficiencia Cardiaca Comunitaria de la Gerencia Metropolitana Sur del Instituto Catalán de la Salud, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Josep Comín-Colet
- Unidad de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (P.M.); (C.E.-G.)
- Programa Territorial de Atención Integrada a la Insuficiencia Cardiaca Comunitaria de la Gerencia Metropolitana Sur del Instituto Catalán de la Salud, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
- Servicio de Cardiologia, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Correspondence: ; Tel.: +34-932-607-078
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Jiménez-Marrero S, Cainzos-Achirica M, Monterde D, Vela E, Cleries M, García-Eroles L, Enjuanes C, Yun S, Garay A, Moliner P, Alcoberro L, Corbella X, Comín-Colet J. Impact on clinical outcomes and health costs of deranged potassium levels in patients with chronic cardiovascular, metabolic, and renal conditions. ACTA ACUST UNITED AC 2020; 74:312-320. [PMID: 32694080 DOI: 10.1016/j.rec.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/04/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES Potassium derangements are frequent among patients with chronic cardiovascular conditions. Studies on the associations between potassium derangements and clinical outcomes have yielded mixed findings, and the implications for health care expenditure are unknown. We assessed the population-based associations between hyperkalemia, hypokalemia and clinical outcomes and health care costs, in patients with chronic heart failure, chronic kidney disease, diabetes mellitus, hypertension, and ischemic heart disease. METHODS Population-based, longitudinal study including up to 36 269 patients from a health care area with at least one of the above-mentioned conditions. We used administrative, hospital and primary care databases. Participants were followed up between 2015 and 2017, were aged ≥ 55 years and had at least 1 potassium measurement. Four analytic designs were used to evaluate prevalent and incident cases and the use of renin-angiotensin-aldosterone system inhibitors. RESULTS Hyperkalemia was twice as frequent as hypokalemia. On multivariable-adjusted analyses, hyperkalemia was robustly and significantly associated with an increased risk of all-cause death (HR from Cox regression models ranging from 1.31-1.68) and with an increased odds of a yearly health care expenditure >85th percentile (OR, 1.21-1.29). Associations were even stronger in hypokalemic patients (HR for all-cause death, 1.92-2.60; OR for health care expenditure> percentile 85th, 1.81-1.85). CONCLUSIONS Experimental studies are needed to confirm whether the prevention of potassium derangements reduces mortality and health care expenditure in these chronic conditions. Until then, our findings provide observational evidence on the potential importance of maintaining normal potassium levels.
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Affiliation(s)
- Santiago Jiménez-Marrero
- Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Miguel Cainzos-Achirica
- Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore (MD), United States; Facultad de Medicina y Ciencias de la Salud, Universidad Internacional de Cataluña, Barcelona, Spain
| | - David Monterde
- Unitat d'Informació i Coneixement, Servei Català de la Salut (CatSalut), Barcelona, Spain
| | - Emili Vela
- Unitat d'Informació i Coneixement, Servei Català de la Salut (CatSalut), Barcelona, Spain
| | - Montse Cleries
- Unitat d'Informació i Coneixement, Servei Català de la Salut (CatSalut), Barcelona, Spain
| | - Luis García-Eroles
- Unitat d'Informació i Coneixement, Servei Català de la Salut (CatSalut), Barcelona, Spain
| | - Cristina Enjuanes
- Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Yun
- Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alberto Garay
- Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Moliner
- Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lidia Alcoberro
- Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Grupo de Evaluación de Determinantes de Salud y Políticas Sanitarias, Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Josep Comín-Colet
- Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Departamento de Ciencias Clínicas, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain.
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46
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Moliner P, Comin-Colet J. First episode of acute heart failure: Can we already predict the risk of short-term mortality? Eur J Intern Med 2020; 77:30-31. [PMID: 32423637 DOI: 10.1016/j.ejim.2020.04.041] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Pedro Moliner
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Cardio-Oncology Unit, Cardiology Department, Bellvitge University Hospital-Catalan Institute of Oncology (ICO), L'Hospital de Llobregat, Barcelona, Spain.
| | - Josep Comin-Colet
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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47
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Santiago‐Vacas E, Lupón J, Gavidia‐Bovadilla G, Gual‐Capllonch F, Antonio M, Domingo M, Núñez J, Zamora E, Teis A, Moliner P, Codina P, Santesmases J, Bayes‐Genis A. Pulmonary hypertension and right ventricular dysfunction in heart failure: prognosis and 15‐year prospective longitudinal trajectories in survivors. Eur J Heart Fail 2020; 22:1214-1225. [DOI: 10.1002/ejhf.1862] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Evelyn Santiago‐Vacas
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol Badalona Spain
- Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Spain
- Department of Medicine Universitat de Barcelona Barcelona Spain
| | - Josep Lupón
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol Badalona Spain
- Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Spain
- Department of Medicine Universitat Autònoma de Barcelona Barcelona Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III Madrid Spain
| | | | | | - Marta Antonio
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol Badalona Spain
- Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Mar Domingo
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Julio Núñez
- CIBER Cardiovascular, Instituto de Salud Carlos III Madrid Spain
- Cardiology Department Hospital Clínico Universitario, INCLIVA València Spain
- Department of Medicine Universitat de València València Spain
| | - Elisabet Zamora
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol Badalona Spain
- Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Spain
- Department of Medicine Universitat Autònoma de Barcelona Barcelona Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III Madrid Spain
| | - Albert Teis
- Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Pedro Moliner
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol Badalona Spain
- Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Pau Codina
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol Badalona Spain
- Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Javier Santesmases
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Antoni Bayes‐Genis
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol Badalona Spain
- Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Spain
- Department of Medicine Universitat Autònoma de Barcelona Barcelona Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III Madrid Spain
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48
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Alcaide-Aldeano A, Garay A, Alcoberro L, Jiménez-Marrero S, Yun S, Tajes M, García-Romero E, Díez-López C, González-Costello J, Mateus-Porta G, Cainzos-Achirica M, Enjuanes C, Comín-Colet J, Moliner P. Iron Deficiency: Impact on Functional Capacity and Quality of Life in Heart Failure with Preserved Ejection Fraction. J Clin Med 2020; 9:jcm9041199. [PMID: 32331365 PMCID: PMC7230551 DOI: 10.3390/jcm9041199] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022] Open
Abstract
The effects of iron deficiency (ID) have been widely studied in heart failure (HF) with reduced ejection fraction. On the other hand, studies in HF with preserved ejection fraction (HFpEF) are few and have included small numbers of participants. The aim of this study was to assess the role that ID plays in functional capacity and quality of life (QoL) in HFpEF while comparing several iron-related biomarkers to be used as potential predictors. ID was defined as ferritin <100 ng/mL or transferrin saturation <20%. Submaximal exercise capacity, measured by the 6-min walking test (6MWT), and QoL, assessed by the Minnesotta Living with Heart Failure Questionnaire (MLHFQ), were compared between iron deficient patients and patients with normal iron status. A total of 447 HFpEF patients were included in the present cross-sectional study, and ID prevalence was 73%. Patients with ID performed worse in the 6MWT compared to patients with normal iron status (ID 271 ± 94 m vs. non-ID 310 ± 108 m, p < 0.01). They also scored higher in the MLHFQ, denoting worse QoL (ID 49 ± 22 vs. non-ID 43 ± 23, p = 0.01). Regarding iron metabolism biomarkers, serum soluble transferrin receptor (sTfR) was the strongest independent predictor of functional capacity (β = −63, p < 0.0001, R2 0.39) and QoL (β = 7.95, p < 0.0001, R2 0.14) in multivariate models. This study postulates that ID is associated with worse functional capacity and QoL in HFpEF as well, and that sTfR is the best iron-related biomarker to predict both. Our study also suggests that the effects of ID could differ among HFpEF patients by left ventricular ejection fraction.
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Affiliation(s)
- Alex Alcaide-Aldeano
- University of Barcelona, School of Medicine, 08036 Barcelona, Spain; (A.A.-A.); (J.G.-C.); (J.C.-C.)
| | - Alberto Garay
- Community Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (L.A.); (S.J.-M.); (S.Y.); (M.T.); (C.E.)
| | - Lídia Alcoberro
- Community Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (L.A.); (S.J.-M.); (S.Y.); (M.T.); (C.E.)
| | - Santiago Jiménez-Marrero
- Community Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (L.A.); (S.J.-M.); (S.Y.); (M.T.); (C.E.)
| | - Sergi Yun
- Community Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (L.A.); (S.J.-M.); (S.Y.); (M.T.); (C.E.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (E.G.-R.); (C.D.-L.)
- Department of Internal Medicine, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Marta Tajes
- Community Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (L.A.); (S.J.-M.); (S.Y.); (M.T.); (C.E.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (E.G.-R.); (C.D.-L.)
| | - Elena García-Romero
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (E.G.-R.); (C.D.-L.)
- Advanced Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Carles Díez-López
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (E.G.-R.); (C.D.-L.)
- Advanced Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - José González-Costello
- University of Barcelona, School of Medicine, 08036 Barcelona, Spain; (A.A.-A.); (J.G.-C.); (J.C.-C.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (E.G.-R.); (C.D.-L.)
- Advanced Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Gemma Mateus-Porta
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
| | - Cristina Enjuanes
- Community Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (L.A.); (S.J.-M.); (S.Y.); (M.T.); (C.E.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (E.G.-R.); (C.D.-L.)
| | - Josep Comín-Colet
- University of Barcelona, School of Medicine, 08036 Barcelona, Spain; (A.A.-A.); (J.G.-C.); (J.C.-C.)
- Community Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (L.A.); (S.J.-M.); (S.Y.); (M.T.); (C.E.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (E.G.-R.); (C.D.-L.)
| | - Pedro Moliner
- Community Heart Failure Unit, Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (L.A.); (S.J.-M.); (S.Y.); (M.T.); (C.E.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (E.G.-R.); (C.D.-L.)
- Correspondence: ; Tel.: +34-9-3260-7500
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Julián MT, Alonso N, Lupón J, Gavidia-Bovadilla G, Ferrer E, de Antonio M, López-Ayerbe J, Domingo M, Santiago-Vacas E, Zamora E, Codina P, Moliner P, Núñez J, Santesmases J, Puig-Domingo M, Bayes-Genis A. Long-term LVEF trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline. Cardiovasc Diabetol 2020; 19:38. [PMID: 32293458 PMCID: PMC7092450 DOI: 10.1186/s12933-020-01011-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/07/2020] [Indexed: 12/11/2022] Open
Abstract
Background Left ventricular ejection fraction (LVEF) trajectories and functional recovery with current heart failure (HF) management is increasingly recognized. Type 2 diabetes mellitus (T2D) leads to a worse prognosis in HF patients. However, it is unknown whether T2D interferes with LVEF trajectories. The aim of this study was to prospectively assess very long-term (up to 15 years) LVEF trajectories in patients with and without T2D and underlying HF. Methods Ambulatory patients admitted to a multidisciplinary HF clinic were prospectively evaluated by scheduled two-dimensional echocardiography at baseline, 1 year, and then every 2 years afterwards, up to 15 years. Statistical analyses of LVEF change with time were performed using the linear mixed effects (LME) models, and locally weighted error sum of squares (Loess) curves were plotted. Results Of the 1921 patients, 461 diabetic and 699 non-diabetic patients with LVEF < 50% were included in the study. The mean number of echocardiography measurements performed in diabetic patients was 3.3 ± 1.6. Early LVEF recovery was similar in diabetic and non-diabetic patients, but Loess curves showed a more pronounced inverted U shape in diabetics with a more pronounced decline after 9 years. LME analysis showed a statistical interaction between T2D and LVEF trajectory over time (p = 0.009), which was statistically significant in patients with ischemic etiologies (p < 0.001). Other variables that showed an interaction between LVEF trajectories and T2D were male sex (p = 0.04) and HF duration (p = 0.008). Conclusions LVEF trajectories in T2D patients with depressed systolic function showed a pronounced inverted U shape with a marked decline after 9 years. Diabetic cardiomyopathy may underlie the functional decline observed.
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Affiliation(s)
- María Teresa Julián
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Endocrinology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Núria Alonso
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. .,Endocrinology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. .,Centre of Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain. .,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Josep Lupón
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Giovana Gavidia-Bovadilla
- Department of e-Health, Eurecat, Technological Center of Catalonia, Barcelona, Spain.,Cardiology Department, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Elena Ferrer
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Marta de Antonio
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jorge López-Ayerbe
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Mar Domingo
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Evelyn Santiago-Vacas
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elisabet Zamora
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Pau Codina
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Pedro Moliner
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Julio Núñez
- Department of e-Health, Eurecat, Technological Center of Catalonia, Barcelona, Spain.,Cardiology Department, Hospital Clínico Universitario, INCLIVA, Valencia, Spain.,Department of Medicine, Universitat de València, Valencia, Spain
| | - Javier Santesmases
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Puig-Domingo
- Endocrinology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antoni Bayes-Genis
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
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50
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Moliner P, Enjuanes C, Tajes M, Cainzos-Achirica M, Lupón J, Garay A, Jimenez-Marrero S, Yun S, Farré N, Cladellas M, Díez C, Gonzalez-Costello J, Comin-Colet J. Association Between Norepinephrine Levels and Abnormal Iron Status in Patients With Chronic Heart Failure: Is Iron Deficiency More Than a Comorbidity? J Am Heart Assoc 2020; 8:e010887. [PMID: 30760082 PMCID: PMC6405646 DOI: 10.1161/jaha.118.010887] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Mechanisms underlying iron homeostasis dysregulation in patients with chronic heart failure remain unsettled. In cardiomyocyte models, norepinephrine may lead to intracellular iron depletion, but the potential association between catecholamines (sympathetic activation markers) and iron metabolism biomarkers in chronic heart failure is unknown. Methods and Results In this cross‐sectional analysis, we studied the association between plasma norepinephrine levels and serum iron status biomarkers indicating iron storage (ferritin), iron transport (transferrin saturation), and iron demand (soluble transferrin receptor) in a prospective cohort of 742 chronic heart failure patients (mean age, 72±11 years; 56% male). Impaired iron status was defined as ferritin <100 μg/L or transferrin saturation <20%. Impaired iron status was observed in 69% of patients. In multivariate models, greater norepinephrine levels were associated with impaired iron transport (transferrin saturation <20%, odds ratio=2.28; 95% CI [1.19–4.35]; P=0.013), but not with impaired iron storage (ferritin <100 μg/L, odds ratio=1.25; 95% CI [0.73–2.16]; P=0.415). Norepinephrine was a significant predictor of increased iron demand (soluble transferrin receptor, standardized β‐coefficient=0.12; P=0.006) and low transferrin saturation (standardized β‐coefficient=−0.12; P=0.003). However, norepinephrine levels were not associated with iron or ferritin levels (P>0.05). Adjusted norepinephrine marginal means were significantly higher in patients with impaired iron status compared with those with normal iron status (528 pg/mL [505–551] versus 482 pg/mL [448–518], respectively; P=0.038). Conclusions In chronic heart failure patients, increased sympathetic activation estimated with norepinephrine levels is associated with impaired iron status and, particularly, dysregulation of biomarkers suggesting impaired iron transport and increased iron demand. Whether the relationship between norepinephrine and iron metabolism is bidirectional and entails causality need to be elucidated in future research.
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Affiliation(s)
- Pedro Moliner
- 1 Heart Failure Unit Department of Cardiology Hospital Universitari Germans Trias i Pujol Badalona Spain.,2 Department of Medicine Universitat Autònoma de Barcelona Spain
| | - Cristina Enjuanes
- 3 Community Heart Failure Program Cardiology Department Bellvitge University Hospital Hospitalet de Llobregat Barcelona Spain.,4 Cardiovascular Diseases Research Group Bellvitge Biomedical Research Institute (IDIBELL) Hospitalet de Llobregat Barcelona Spain.,5 Heart Diseases Biomedical Research Group Program of Research in Inflammatory and Cardiovascular Disorders Hospital del Mar Biomedical Research Institute (IMIM) Barcelona Spain
| | - Marta Tajes
- 5 Heart Diseases Biomedical Research Group Program of Research in Inflammatory and Cardiovascular Disorders Hospital del Mar Biomedical Research Institute (IMIM) Barcelona Spain
| | - Miguel Cainzos-Achirica
- 3 Community Heart Failure Program Cardiology Department Bellvitge University Hospital Hospitalet de Llobregat Barcelona Spain.,4 Cardiovascular Diseases Research Group Bellvitge Biomedical Research Institute (IDIBELL) Hospitalet de Llobregat Barcelona Spain.,6 Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Department of Cardiology Johns Hopkins Medical Institutions Baltimore MD.,7 School of Medicine and Medical Sciences Universitat Internacional de Catalunya Sant Cugat del Valles Barcelona Spain
| | - Josep Lupón
- 1 Heart Failure Unit Department of Cardiology Hospital Universitari Germans Trias i Pujol Badalona Spain.,2 Department of Medicine Universitat Autònoma de Barcelona Spain
| | - Alberto Garay
- 3 Community Heart Failure Program Cardiology Department Bellvitge University Hospital Hospitalet de Llobregat Barcelona Spain.,4 Cardiovascular Diseases Research Group Bellvitge Biomedical Research Institute (IDIBELL) Hospitalet de Llobregat Barcelona Spain
| | - Santiago Jimenez-Marrero
- 3 Community Heart Failure Program Cardiology Department Bellvitge University Hospital Hospitalet de Llobregat Barcelona Spain.,4 Cardiovascular Diseases Research Group Bellvitge Biomedical Research Institute (IDIBELL) Hospitalet de Llobregat Barcelona Spain
| | - Sergi Yun
- 3 Community Heart Failure Program Cardiology Department Bellvitge University Hospital Hospitalet de Llobregat Barcelona Spain.,4 Cardiovascular Diseases Research Group Bellvitge Biomedical Research Institute (IDIBELL) Hospitalet de Llobregat Barcelona Spain
| | - Núria Farré
- 2 Department of Medicine Universitat Autònoma de Barcelona Spain.,5 Heart Diseases Biomedical Research Group Program of Research in Inflammatory and Cardiovascular Disorders Hospital del Mar Biomedical Research Institute (IMIM) Barcelona Spain.,8 Heart Failure Program Department of Cardiology Hospital del Mar Parc de Salut Mar Barcelona Spain
| | - Mercé Cladellas
- 2 Department of Medicine Universitat Autònoma de Barcelona Spain.,9 Department of Cardiology Hospital del Mar Parc de Salut Mar Barcelona Spain
| | - Carles Díez
- 4 Cardiovascular Diseases Research Group Bellvitge Biomedical Research Institute (IDIBELL) Hospitalet de Llobregat Barcelona Spain.,10 Advanced Heart Failure and Heart Transplant Unit Department of Cardiology Bellvitge University Hospital Hospitalet de Llobregat Barcelona Spain
| | - Jose Gonzalez-Costello
- 4 Cardiovascular Diseases Research Group Bellvitge Biomedical Research Institute (IDIBELL) Hospitalet de Llobregat Barcelona Spain.,10 Advanced Heart Failure and Heart Transplant Unit Department of Cardiology Bellvitge University Hospital Hospitalet de Llobregat Barcelona Spain
| | - Josep Comin-Colet
- 3 Community Heart Failure Program Cardiology Department Bellvitge University Hospital Hospitalet de Llobregat Barcelona Spain.,4 Cardiovascular Diseases Research Group Bellvitge Biomedical Research Institute (IDIBELL) Hospitalet de Llobregat Barcelona Spain.,5 Heart Diseases Biomedical Research Group Program of Research in Inflammatory and Cardiovascular Disorders Hospital del Mar Biomedical Research Institute (IMIM) Barcelona Spain.,11 Department of Clinical Sciences School of Medicine Universitat de Barcelona Spain
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