This article focuses on the magnitude of the challenge of heart failure, with particular reference to the disease burden in Spain. The text also deals with the difficulty of estimating the size of ...the problem, which stems from the fact that heart failure is a common end-point of numerous conditions. The second part of the article presents some reflections on the value of clinical practice guidelines and on the difficulty of incorporating interventions that have proven their efficacy under the controlled conditions of a clinical trial into everyday clinical practice, thereby maximizing their potential benefits. Finally, some suggestions are made on improving both professionals' adherence to clinical practice guidelines and patients' adherence to recommended treatment.
Coronary revascularization is common in heart failure (HF).
Clinical characteristic and assessment of in-hospital and long-term outcomes in patients hospitalized for HF with or without a previous ...percutaneous coronary intervention (PCI) or a coronary artery bypass grafting (CABG).
The primary endpoint (PE) (all-cause death) and the secondary endpoint (SE) (all-cause death or hospitalization for HF-worsening) were assessed at one-year in 649 inpatients of the ESC-HF Pilot Survey. Additionally, occurrence of death during index hospitalization was evaluated.
PCI/CABG-patients (32.7%) were more frequently male, smokers, had myocardial infarction, hypertension (HT), peripheral artery disease and diabetes. The non-PCI/CABG-patients more often had a cardiogenic shock and died in-hospital. The PE occurred in 33 of the 212 PCI/CABG-patients (15.6%) and in 56 of the 437 non-PCI/CABG-patients (12.8%; P=0.3). The SE occurred in 82 of the 170 PCI/CABG-patients (48.2%) and in 122 of the 346 non-PCI/CABG-patients (35.3%; P=0.01). Independent predictors of the PE in the PCI/CABG-patients were: lower left ventricular ejection fraction, use of antiplatelets; in the non-PCI/CABG-patients were: age, ACS at admission. Independent predictors of the SE in the PCI/CABG-patients were: diabetes, NYHA (New York Heart Association) class at admission, HT; in the non-PCI/CABG-patients were: NYHA class, haemoglobin at admission. Serum sodium concentration at admission was a predictor of the PE and the SE in both groups. Heart rate at discharge was a predictor of the PE and the SE in the non-PCI/CABG patients.
The revascularized HF patients had a similar mortality and higher risk of death or hospitalizationsat 12 months compared with the non-PCI/CABG-patients. The revascularized patients had more comorbidities, while the non-PCI/CABG-patients had a higher incidence of cardiogenic shock and in-hospital mortality.
Our aim was to assess the prognostic value of the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) scale in patients undergoing urgent heart transplantation (HT).
...Retrospective analysis of 111 patients treated with urgent HT at our institution from April, 1991 to October, 2009. Patients were retrospectively assigned to three levels of the INTERMACS scale according to their clinical status before HT.
Patients at the INTERMACS 1 level (n
=
31) more frequently had ischemic heart disease (p
=
0.03) and post-cardiothomy shock (p
=
0.02) than patients at the INTERMACS 2 (n
=
55) and INTERMACS 3-4 (n
=
25) levels. Patients at the INTERMACS 1 level showed higher preoperative catecolamin doses (p
=
0.001), a higher frequency of use of mechanical ventilation (p
<
0.001), intraaortic balloon (p
=
0.002) and ventricular assist devices (p
=
0.002), and a higher frequency of preoperative infection (p
=
0.015). The INTERMACS 1 group also presented higher central venous pressure (p
=
0.02), AST (p
=
0.002), ALT (p
=
0.006) and serum creatinine (p
<
0.001), and lower hemoglobin (p
=
0.008) and creatinine clearance (p
=
0.001). After HT, patients at the INTERMACS 1 level had a higher incidence of primary graft failure (p
=
0.03) and postoperative need for renal replacement therapy (p
=
0.004), and their long-term survival was lower than patients at the INTERMACS 2 (log rank 5.1, p
=
0.023; HR 3.1, IC 95% 1.1-8.8) and INTERMACS 3-4 level (log rank 6.1, p
=
0.013; HR 6.8, IC 95% 1.2-39.1).
Our results suggest that the INTERMACS scale may be a useful tool to stratify postoperative prognosis after urgent HT.
Analizar el valor pronóstico de la escala INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) en pacientes tratados con trasplante cardiaco urgente.
Análisis retrospectivo de 111 pacientes tratados con trasplante cardiaco urgente en nuestro centro entre abril de 1991 y octubre de 2009. Se asignó retrospectivamente a los pacientes a tres niveles de la escala INTERMACS en función de su situación clínica previa al trasplante cardiaco.
Los pacientes del grupo INTERMACS 1 (n
=
31) presentaban mayor frecuencia de cardiopatía isquémica (p
=
0,03) y
shock tras cardiotomía (p
=
0,02) que los pacientes del grupo INTERMACS 2 (n
=
55) y los pacientes del grupo INTERMACS 3-4 (n
=
25), así como mayores dosis de catecolaminas (p
=
0,001), mayor empleo de ventilación mecánica (p
<
0,001), balón de contrapulsación (p
=
0,002) y dispositivos de asistencia ventricular (p
=
0,002) y mayores tasas de infección preoperatoria (p
=
0,015). El grupo INTERMACS 1 también mostraba mayores cifras de presión venosa central (p
=
0,02), GOT (p
=
0,002), GPT (p
=
0,006) y creatinina (p
<
0,001) y menores cifras de hemoglobina (p
=
0,008) y aclaramiento de creatinina (p
=
0,001). Tras el trasplante cardiaco, los pacientes del grupo INTERMACS 1 presentaron mayores incidencias de fracaso primario del injerto (p
=
0,03) y necesidad de terapia de sustitución renal (p
=
0,004), y su supervivencia a largo plazo fue menor que la de los pacientes de los grupos INTERMACS 2 (
log rank
=
5,1; p
=
0,023; razón de riesgos HR
=
3,1; intervalo de confianza IC del 95%, 1,4-6,8) e INTERMACS 3-4 (
log rank
=
6,1; p
=
0,013; HR
=
4; IC del 95%, 1,3-12,3).
Nuestros resultados indican que la escala INTERMACS resulta útil para estratificar el pronóstico postoperatorio tras el trasplante cardiaco urgente.
Heart failure in 2005 Jiménez Navarro, Manuel F; Díez Martínez, Javier; Delgado Jiménez, Juan F ...
Revista española de cardiologia,
2006, Letnik:
59 Suppl 1
Journal Article
Recenzirano
This article is a review of developments reported in the field of heart failure in the last year. It covers advances in epidemiology, pathophysiology and therapy, including cardiac resynchronization ...therapy and heart transplantation. Today, management of heart failure is complex. It depends on the participation of numerous health professionals under the guidance of a cardiologist. The increasing prevalence of heart failure means that continuing research is mandatory.
Abstract
Background
Congenital heart diseases (
CHD
s) have high infant mortality in their severe forms. When adulthood is reached, a heart transplant (
HT
x) may be required. Spanish adult ...population transplanted for
CHD
was analyzed and compared with the most frequent causes of
HT
x and between different subgroups of
CHD
.
Materials and Methods
A total of 6048 patients (
HT
x 1984–2009) were included. Pediatric transplants (<15 yr), combined transplants, re
HT
x, and
HT
x for heart diseases other than idiopathic dilated cardiomyopathy (
IDCM
) and ischemic heart disease (
IHD
) were excluded. Total patients included: 3166 (
IHD
= 1888;
IDCM
= 1223;
CHD
= 55). Subgroups were studied as follows: (1) single ventricle with pulmonary stenosis (n = 18), (2) single ventricle with tricuspid atresia and
G
lenn/
F
ontan surgery (n = 10), (3) congenitally corrected transposition of the great vessels (
TGV
) or with switch atrial surgery (n = 10), and (4)
CHD
with right ventricle overload (n = 17).
Results
Survival probability was different between groups (p = 0.0001). Post hoc analysis showed some differences between groups (
CHD
vs.
IHD
, p = 0.05;
CHD
vs.
IDCM
, p = 0.5;
IHD
vs.
IDCM
, p = 0.0001). Early mortality was different between
CHD
subgroups (group 1 = 19%, group 2 = 40%, group 3 = 0%, group 4 = 29%; p < 0.001); however, overall mortality did not show differences between subgroups (p = 0.5).
Conclusions
The percentage of
S
panish adult
HT
x patients for
CHD
is low (1%). The survival curve is better than for other
HT
x causes (
IHD
). Nevertheless, early mortality was higher, particularly in some subgroups (
F
ontan).
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