To assess whether a sustained optimal haemoglobin value in the 3 months after admission for heart failure (HF) decompensation reduces morbidity and mortality during the 12 months after admission for ...acute HF.
Retrospective study of the 1408 patients older than 65 years included in the RICA registry divided into 3 groups: no anaemia (group A), recovered anaemia (group B), and persistent anaemia (group C), according to haemoglobin levels on admission, and 3 months after discharge. Kaplan-Meier curves were constructed, comparing the groups using the log-rank test and a Cox regression model was performed to analyse survival.
578 (41.1%), 299 (21.2%) and 531 (37.7%) were included in groups A, B and C, respectively. We recorded a total of 768 deaths and readmissions. There were 23 (4%), 12 (4%) and 49 (9.2%), (p=.001) individuals who died due to HF and 154 (27%), 73 (24%) and 193 (36%) (P<.001) admissions for this pathology, respectively. Patients with persistent anaemia had a higher risk of death (RR 1.29, 95% CI 1.04-1.61, P=.024) or readmission (1.92, 95% CI 1.16-3, 19; P=.012) due to HF.
Persistent anaemia in the months after admission for HF increases morbidity and mortality in the subsequent year.
Los pacientes con síndrome de dificultad respiratoria aguda secundario a COVID-19, tienen una forma de presentación atípica, con una discrepancia entre una mecánica pulmonar aceptable y una hipoxia ...marcada. Cada uno de los métodos de oxígeno suplementario usados en la práctica clínica en pacientes con COVID-19 tiene descritas sus indicaciones, ventajas y desventajas. La cánula nasal es el sistema más común y se recomienda en casos de hipoxia leve. El sistema Venturi, que utiliza fracción inspirada de oxígeno exacta con flujos más altos de oxígeno y, la máscara de no re-inhalación, que normalmente se usa ante la falta de respuesta con los dispositivos anteriores, tiene riesgo de producir aerosoles y transmitir la infección. Otra herramienta muy útil es la cánula de alto flujo, la cual es bien tolerada, reduce el trabajo respiratorio, ayuda a prevenir la intubación, es ideal en caso de no tener ventiladores disponibles y cuando los métodos de oxígeno suplementario sean insuficientes para lograr las metas de saturación de oxígeno. En cuanto a la ventilación mecánica no invasiva, existen reportes donde se usa; sin embargo, si el paciente no responde a los tratamientos mencionados, debe ser candidato a ventilación mecánica invasiva sin retraso. Los criterios de intubación orotraqueal son tanto clínicos como gasimétricos. Las metas de saturación de oxígeno son, en general 90-96 %, y no se debe retrasar la intubación y la ventilación mecánica en caso de tener la indicación. Son necesarios más estudios que evalúen la eficacia clínica de los distintos métodos de oxigenación y de soporte ventilatorio no invasivo en estos pacientes.
The liberalisation of trade in services which began in 1995 under the General Agreement on Trade in Services (GATS) of the World Trade Organisation (WTO) has generated arguments for and against its ...potential health effects. Our goal was to explore the relationship between the liberalisation of services under the GATS and three health indicators--life expectancy (LE), under-5 mortality (U5M) and maternal mortality (MM)--since the WTO was established.
This was a cross-sectional ecological study that explored the association in 2010 and 1995 between liberalisation and health (LE, U5M and MM), and between liberalisation and progress in health in the period 1995-2010, considering variables related to economic and social policies such as per capita income (GDP pc), public expenditure on health (PEH), and income inequality (Gini index). The units of observation and analysis were WTO member countries with data available for 2010 (n = 116), 1995 (n = 114) and 1995-2010 (n = 114). We conducted bivariate and multivariate linear regression analyses adjusted for GDP pc, Gini and PEH. Increased global liberalisation in services under the WTO was associated with better health in 2010 (U5M: -0.358 p<0.001; MM: -0.338 p = 0.001; LE: 0.247 p = 0.008) and in 1995, after adjusting for economic and social policy variables. For the period 1995-2010, progress in health was associated with income equality, PEH and per capita income. No association was found with global liberalisation in services.
The favourable association in 2010 between health and liberalisation in services under the WTO seems to reflect a pre-WTO association observed in the 1995 data. However, this liberalisation did not appear as a factor associated with progress in health during 1995-2010. Income equality, health expenditure and per capita income were more powerful determinants of the health of populations.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Department of Hematology, Hospital San Agustin, 33400, Aviles, Spain. jagonzalez@medynet.com
BACKGROUND AND OBJECTIVES: Venous thromboembolism (VTE) involves inflammation and a relation with ...dyslipidemia which remains controversial. The vascular cell adhesion molecule-1 (VCAM-1) is a ligand expressed by activated endothelium (and recruits leukocytes) whose soluble form (sVCAM-1) increases in atherosclerosis, severe hypertriglyceridemia or deep vein thrombosis (DVT) in acute phase. We analyzed the association between VTE (> 6 months after), sVCAM-1 and lipid concentrations. DESIGN AND METHODS: Case-control study involving 126 consecutive patients (aged 25-80 years, 49% males) and 125 controls of similar age and gender. RESULTS: The patients had a more unfavorable lipid profile than controls higher triglycerides (p P90) and HDL-c ( P90) (OR=4.2)(p 970 ng/mL) with TC >250 mg/dL or HDL-c
When acute heart failure progresses and there is acute cardiogenic pulmonary edema, routine therapeutic measures should be accompanied by other measures that help to correct oxygenation of the ...patient. The final and most drastic step is mechanical ventilation. Non-invasive ventilation has been developed in the last few years as a method that attempts to improve oxygenation without the need for intubation, thus, in theory, reducing morbidity and mortality in these patients. The present article describes the controversies surrounding the results of this technique and discusses its indications. The article also discusses how to start non-invasive ventilation in patients with acute pulmonary edema from a practical point of view.
There is great interest in better characterizing patients with heart failure (HF) with preserved ejection fraction (HF-PEF). The objective of this study is to determine the prevalence, progression ...over time and to describe the clinical and epidemiological characteristics of patients with HF-PEF.
From the National Registry of Heart Failure (RICA, prospective multicentre cohort study) we analysed patients consecutively admitted for HF in Internal Medicine wards over a period of 11 years (2008–2018).
4752 patients were included, 2957 (62.2%) with preserved ejection fraction. This prevalence remained constant from 2008 to 2019. Compared to patients with HF and reduced ejection fraction (HF-REF) patients with HF-PEF are older, more are female, there is a higher prevalence of hypertensive and valvular aetiology, they have a profile of different comorbidities and worse functional status. A high proportion of patients receive disease-modifying treatment for IC-REF (renin-angiotensin-aldosterone system inhibitors and beta-blockers). The overall mortality after one-year follow-up was 24% and 30% in the HF-PEF and the HF-REF, respectively. In the multivariate analysis, the risk of death was higher in patients with HF-REF compared to HF-PEF (OR 1.84; 95% CI 1.43–2.36). The length of hospital stay was also lower in the HF-PEF patients but there were no differences in re-hospitalizations.
Sixty percent of patients in the RICA registry have preserved ejection fraction. These patients have a higher comorbidity burden and a worse functional status, but lower mortality compared with HF-REF patients.
La caracterización de los pacientes con insuficiencia cardiaca (IC) con fracción de eyección preservada (IC-FEp) sigue teniendo interés. El objetivo fue conocer la prevalencia, características clínicas y epidemiológicas de la IC-FEp, y sus cambios en los últimos años.
Analizamos el Registro RICA, de la Sociedad Española de Medicina Interna; estudio de cohorte multicéntrico y prospectivo, de pacientes ingresados por IC, consecutivamente en servicios de Medicina Interna, durante un periodo de 11 años (2008–2018).
Se incluyeron 4752 pacientes, 2957 (62,2%) con IC-FEp, proporción que se mantuvo constante durante todo el periodo. En comparación con los pacientes con IC y fracción de eyección reducida (IC-FEr), los pacientes con IC-FEp tienen: mayor edad, predominio de sexo femenino, etiología hipertensiva y valvular, distinto perfil de comorbilidades y peor capacidad funcional (menor índice de Barthel). La mayoría de pacientes recibía un tratamiento similar al de la IC-FEr (inhibidores del sistema renina-angiotensina-aldosterona y beta-bloqueantes). La mortalidad global al año de seguimiento fue del 24% en la IC-FEp y 30% en la IC-FEr. En el análisis multivariante el riesgo de muerte fue superior en los pacientes con IC-FEr (HR 1,84; IC 95% 1,43–2,36); la estancia hospitalaria fue inferior en la IC-FEp y no hubo diferencias en las re-hospitalizaciones.
La IC-FEp se mantiene como una entidad muy prevalente. Supone el 60% de los ingresos por IC en los servicios de Medicina Interna. Se acompaña de una elevada comorbilidad y deterioro funcional pero su mortalidad es menor que la de la IC-FEr.
The impact of atrial fibrillation (AF) on the prognosis of heart failure with preserved ejection fraction (HFpEF) is still the subject of debate. We analysed the influence of AF on the prognosis on ...mortality and readmission in patients with HFpEF.
Prospective observational study in 1971 patients with HFpEF, who were admitted for acute heart failure. Patients were divided into 2 groups according to the presence or absence of AF. We analysed mortality, readmissions and combined mortality/readmissions at one-year follow-up.
A total of 1177 (59%) patients had AF, mean age 80.3 (7.8) years and 1233 (63%) were women. Patients with HFpEF and AF were older, female, greater valvular aetiology and lower comorbidity measured by the Charlson index. At the one-year follow-up, 430 (22%) patients had died and 840 (43%) had been readmitted. In the 2 groups analysed, there was no difference in all-cause mortality (22 vs. 21%; p=0.739, AF vs. no-AF, respectively) or cardiovascular causes (9.6 vs. 8.2%; p=0.739, AF vs. no-AF, respectively). In the multivariable analysis, factors associated with higher mortality were: age, male, valvular aetiology, uric acid, and comorbidity. In the analysis of the subgroup with HFpEF with AF, the presence of chronic AF compared to de novo AF was associated with higher mortality (HR 1716; 95% CI 1099–2681; p=0.018).
In patients with HFpEF, the presence of AF is frequent. During the one-year follow-up, the presence of AF does not influence mortality or readmissions in patients with HFpEF.
La información del impacto de la fibrilación auricular (FA) en el pronóstico de los pacientes con insuficiencia cardiaca con fracción de eyección preservada (IC-FEP) es controvertido. Se analizó el pronóstico en cuanto a la mortalidad y los reingresos al año de los pacientes con IC-FEP y FA.
Estudio observacional y prospectivo en 1.971 pacientes con IC-FEP, que presentan un ingreso por IC aguda. Los pacientes se dividieron en 2 grupos según la presencia o no de FA. Analizamos la mortalidad, los reingresos y el combinado mortalidad/reingresos al año de seguimiento.
Un total de 1.177 (59%) pacientes presentaban FA, con una edad media de 80,3 (7,8) años, y de ellos, 1.233 (63%) eran mujeres. El paciente con IC-FEP y FA tenía una mayor edad, era del sexo femenino y presentaba más frecuentemente un origen valvular y una menor comorbilidad medida por el índice de Charlson. Al año de seguimiento, 430 (22%) pacientes murieron y 840 (43%) fueron reingresados. Entre los 2 grupos analizados no hubo diferencia en la mortalidad por todas las causas (22 vs. 21%; p=0,739, FA vs. no FA, respectivamente) ni por causas cardiovasculares (9,6 vs. 8,2%; p=0,739, FA vs. no FA, respectivamente). En el análisis multivariable se asociaron con mayor mortalidad: la edad, el sexo masculino, la etiología valvular, la hiperuricemia y la comorbilidad. En el análisis del subgrupo con IC-FEP con FA, la presencia de FA crónica comparada con la FA de novo se asoció con una mayor mortalidad (HR 1,716; IC 95% 1,099-2,681; p=0,018).
En pacientes con IC-FEP es frecuente la presencia de FA. Durante el seguimiento a un año, la presencia de FA no influye en la mortalidad ni en los reingresos hospitalarios en pacientes con IC-FEP.
Introduction: Cardiac amyloidosis (CA) has been considered a rare disease, but different studies show that its prevalence is higher than previously thought. Previous studies carried out on the ...prevalence of CA are heterogeneous and provide inconclusive and changing data over time that do not allow us to know the real prevalence of this pathology. In Spain, 60% of patients with heart failure (HF) admitted to hospitals are cared for in Internal Medicine Services, and their follow-up is carried out by internists, but there are no prevalence studies in this type of Internal Medicine patients. The PREVAMIC is a study designed by the HF Working Group of the Spanish Society of Internal Medicine to known the Prevalence of CA in HF patients cared by internists. Objectives: The main objective is to estimate the prevalence of different types of CA in patients with HF, aged 65 years and older, with left ventricular hypertrophy, managed in Internal Medicine departments. Secondary objectives are to describe clinical, laboratory, and echocardiographic features of patients with CA and to compare 1-year readmissions and mortality rates in patients with and without CA. Methods: A multicenter, observational, cross-sectional, prospective, cohort study with a 1-year follow-up. Inclusion criteria: Inpatients or outpatients with HF, aged ≥ 65 years, both genders, with septum or posterior wall > 12 mm, under the care of internists. Conclusions: Our prospective investigation study aims to improve knowledge about the prevalence of CA in patients with HF treated in the Internal Medicine setting.
Introduction and objectives: Cardiac amyloidosis (CA) is not a rare cause of heart failure (HF). In Spain, more than 60% of HF patients admitted to hospitals are treated in Internal Medicine ...Services. REGAMIC is a registry designed by the HF Working Group of the Spanish Society of Internal Medicine to improve the suspicion criteria and the selection of patients in whom CA must be ruled out. The main objective is to evaluate the differential characteristics between two groups of HF patients with suspicion of CA: confirmed vs ruled out cases. The secondary objectives are to evaluate the data on which investigators have based the suspicion of CA, and to identify prognostic differences between both groups. Methods: A multicenter, observational, prospective, cohort study of at least 600 patients, with a 2-year follow-up. Inclusion criteria: patients of Internal Medicine Services, aged ≥ 18 years, with HF and left ventricular hypertrophy (septum or posterior wall ≥ 12 mm), with suspicion of CA. Clinical, electrocardiographic, echocardiographic, and follow-up data will be compared between both groups of patients. Results and discussion: If the recommendations of the 2021 European Society of Cardiology Consensus on CA are followed, a large number of patients should be studied to rule out CA. REGAMIC can improve the selection of patients in whom CA will be ruled out and make the study more cost-effective. Conclusions: Our registry aims to improve the knowledge about differential characteristics between HF patients with clinical suspicion of CA and may increase knowledge of the natural history of the disease.
PDF
