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We assessed differences in long-term all-cause and cardiovascular (CV) mortality in heart failure (HF) outpatients based on the etiology of HF. Consecutive patients admitted to the HF Clinic from August 2001 to September 2019 (N = 2587) were considered for inclusion. HF etiology was divided into ischemic heart disease (IHD), dilated cardiomyopathy (DCM), hypertensive heart disease, alcoholic cardiomyopathy, drug-induced cardiomyopathy (DICM), valvular heart disease, and hypertrophic cardiomyopathy. All-cause death and CV death were the primary end points. Among 2387 patients included in the analysis (mean age 66.5 ± 12.5 years, 71.3% men), 1317 deaths were recorded (731 from CV cause) over a maximum follow-up of 18 years (median 4.1 years, interquartile range (IQR) 2–7.8). Considering IHD as the reference, only DCM had a lower risk of all-cause death (adjusted hazard ratio (aHR) 0.68, 95% confidence interval (CI) 0.56–0.83, p < 0.001), and only DICM had a higher risk of all-cause death (aHR 1.47, 95% CI 1.02–2.11, p = 0.04). However, almost all etiologies had a significantly lower risk of CV death than IHD. Among the studied HF etiologies, DCM and DICM have the lowest and highest risk of all-cause death, respectively, whereas IHD has the highest adjusted risk of CV death.

Background Neprilysin serum levels (sNEP) exhibited significant prognostic value in patients with heart failure (HF). In the PARADIGM-HF study benefit of sacubitril/valsartan was observed in patients with reduced ejection fraction (HFrEF), while in the PARAGON-HF benefit was only observed in the subgroup of patients with LVEF Objective To assess the prognostic value of sNEP in ambulatory patients with HF and preserved ejection fraction (HFpEF) and LVEF >57% (group 1), in comparison with patients with LVEF ≤57% (group 2). Methods Consecutive patients with HF attended at the Unit from May 2006 to February 2016 were considered for the study. The primary end-point was the composite of cardiovascular death or HF hospitalization. All-cause death, cardiovascular death, HF hospitalization and the composite of all-cause death or HF hospitalization were secondary end-points. Competing risk methods (R package by Bob Gray for SPSS) were used when required. Results sNEP was measured in 1428 patients (age 67.7±12.7, 70.3% men, LVEF 35.8% ±14, 48.9% from ischemic etiology), 144 of which had a LVEF >57% (age 70.1±15, 43.8% men, 53.5% from hypertensive or valvular etiologies). sNEP levels did not significantly differ between the two groups of patients (p=0.31). During a mean follow-up of 6±3.9 years, 856 deaths were recorded (459 from cardiovascular causes) and 523 patients suffered at least one HF hospitalization. The primary end-point occurred in 941 patients (in 111 of the 144 patients with LVEF >57%). Table 1 shows sNEP age- and sex-adjusted hazard ratios for the primary and secondary end-points. Conclusions sNEP prognostic value in patients with HFpEF and LVEF >57% outperforms that observed in patients with lower LVEF. These data support the personalized use of sNEP in identifying HFpEF patients that may benefit from treatment with sacubitril/valsartan. Funding Acknowledgement Type of funding source: None

Background Advances in heart failure (HF) treatment have achieved a reduction of death in HF patients in the last two decades. Indeed, not only mortality has been reduced but also the mode of death might have been modified through these years. Purpose To assess the causes of death in outpatients attended in a HF Unit since the year 2002 up to the year 2018. Methods Causes of death were classified as follows: progression of HF (worsening HF or treatment-resistant HF, in the absence of another cause); sudden death (any unexpected death, witnessed or not, of a previously stable patient with no evidence of worsening HF or any other known cause of death); acute myocardial infarction; stroke; procedural (post-diagnostic or post-therapeutic); other cardiovascular causes (e.g., rupture of an aneurysm, peripheral ischemia, or aortic dissection), and non-cardiovascular. Patients who died of unknown cause were excluded from the analysis. Fatal events were identified from the clinical records of patients with HF, hospital wards, the emergency room, general practitioners, or by contacting the patient's relatives. Furthermore, data were verified from the databases of the Catalan and Spanish Health Systems. Trends on every cause of death were assessed by linear regression. Results Since August 2001 to May 2018, 2295 HF patients were admitted to the HF clinic (age 66.4±12.8 years, 71% men, 49% from ischemic aetiology, mean LVEF 35.2% ± 14). During the 17 years of the study, 1201 deaths were recorded. Seventy-eight patients (6.5% of deaths) were excluded due to unknown cause of death. The evolution in the mode of death by years is shown in the figure. Two trends were observed: a decrease in sudden death (p=0.05) and a very significant linear increase in non-cardiovascular causes of death (p Conclusions During the 17 years of the study, a very significant trend towards higher percentage of non-cardiovascular deaths was progressively observed. On the other hand, percentage of sudden death showed a gradual decrease, mainly driven from the changes observed in the first 10 years.

Background The role of lung ultrasound (LUS) in diagnosis and response to diuretic treatment of patients with acute HF has been widely studied, but less is known about its value in chronic HF. Purpose To assess the prognostic value of LUS in a cohort of chronic HF stable ambulatory patients and to explore the relationship of LUS findings with clinical data, such as NYHA functional class, left ventricular ejection fraction (LVEF) and NTproBNP. Methods Consecutive stable ambulatory patients who attended a scheduled follow-up visit in a HF clinic were included. LUS were performed with a pocket device and examined 4 chest areas per side (two anterior and two lateral). Scans were analysed offline by two investigators blinded to clinical data, who evaluated the number of B-lines of each area. The addition number of B-lines of each area and the quartiles of such addition were used for the analyses. The primary outcome end-point was the composite of all-cause death or hospitalization due to HF at one year. Linear regression and Cox regression analyses were performed. Results Five-hundred seventy-seven patients were included between July 2016 and July 2017 (age 69±12 years, 72% men). The main HF aetiology was ischemic heart disease (43%) followed by dilated cardiomyopathy (20%). Median HF duration was 79 months (Q1-Q3 38–144). Mean LVEF was 45%±13 (mean LVEF when admitted at the Unit 34%±13). Most patients were in NYHA functional class II (70%), 13% were in class I and 17% in class III. Median NTproBNP was 722 ng/L (Q1-Q3 262–1760). Mean number of B-lines was 5±6 (Q1, 0; Q2, 1–3; Q3, 4–7; Q4, ≥8). The number of B-lines was associated with age (beta-coefficient 0.11, p Conclusion In outpatients with stable chronic HF, the number of B-lines detected in LUS was associated with age, NYHA functional class and NTproBNP. Patients having ≥8 B-lines had a significant double risk of HF related hospitalization or all-cause death at one year. However, when strongly powerful prognostic variables such as NYHA class and NTproBNP were included in the model LUS did not retain an independent prognostic role.

Objective: To assess the effects of comorbidities, fragility, and quality of life (QOL) on long-term prognosis in ambulatory patients with heart failure (HF) with midrange left ventricular ejection fraction (HFmrEF), an unexplored area. Patients and Methods: Consecutive patients prospectively evaluated at an HF clinic between August 1, 2001, and December 31, 2015, were retrospectively analyzed on the basis of left ventricular ejection fraction category. We compared patients with HFmrEF (n=185) to those with reduced (HFrEF; n=1058) and preserved (HFpEF; n=162) ejection fraction. Fragility was defined as 1 or more abnormal evaluations on 4 standardized geriatric scales (Barthel Index, Older Americans Resources and Services scale, Pfeiffer Test, and abbreviated-Geriatric Depression Scale). The QOL was assessed with the Minnesota Living with Heart Failure Questionnaire. A comorbidity score (0-7) was constructed. All-cause death, HF-related hospitalization, and the composite end point of both were assessed. Results: Comorbidities and QOL scores were similar in HFmrEF (2.41±1.5 and 30.1±18.3, respectively) and HFrEF (2.30±1.4 and 30.8±18.5, respectively) and were higher in HFpEF (3.02±1.5, P

Background Heart failure (HF) is a chronic condition with poor prognosis, and has a high prevalence among older adults. Due to older age, fragility is often present among HF patients. However, even young HF patients show a high degree of fragility. The effect of fragility on long-term prognosis in HF patients, irrespective of age, remains unexplored. The aim of this study was to assess the influence of fragility on long-term prognosis in outpatients with HF. Methods and results At least one abnormal evaluation among four standardized geriatric scales was used to identify fragility. Predefined criteria for such scales were: Barthel Index, 3 (±1, depending on educational grade); and ≥1 positive response for depression on the abbreviated Geriatric Depression Scale (GDS). We assessed 1314 consecutive HF outpatients (27.8% women, mean age years 66.7±12.4years with different etiologies. Fragility was detected in 581 (44.2%) patients. 626 deaths occurred during follow-up; the median follow-up was 3.6years [P 25 –P 75 : 1.8–6.7] for the total cohort, and 4.9years [P 25 –P 75 : 2.5–8.4] for living patients. Fragility and its components were significantly associated with decreased survival by univariate analysis. In a comprehensive multivariable Cox regression analysis, fragility remained independently associated with survival in the entire cohort, and in age and left ventricular ejection fraction subgroups. Conclusion Fragility is a key determinant of survival in ambulatory patients with HF across all age strata.

Heart failure (HF) is a chronic disease that frequently causes quality of life (QoL) impairment. We aimed to evaluate whether fragility affects QoL perception in outpatients with HF across age strata. The Minnesota Living with Heart Failure Questionnaire (MLWHFQ) was used to assess QoL, and fragility was defined according to basic standardized geriatric scales. Predefined criteria for such scales were scores of Barthel index90, Older Americans' Resources and Services scale10 in women and6 in men, and Pfeiffer test3 (±1 depending on educational grade) and ≥1 positive depression response on the abbreviated Geriatric Depression Scale. We evaluated 1,405 consecutive outpatients with HF (27.8% women, median age 69 years [twenty-fifth to seventy-fifth percentiles: 59 to 76 years]). Fragility, defined as at least 1 abnormal evaluation, was detected in 621 patients (44.2%). A positive depression response on the abbreviated Geriatric Depression Scale was the most prevalent (31.2%) component of fragility. We found a strong correlation between MLWHFQ score and the presence of fragility and all fragility components (all p0.001). These associations prevailed in both younger (75 years) and older patients (≥75 years; all p values0.001 except for Pfeiffer test in younger patients [p = 0.007]). In multivariate regression analysis, QoL remained significantly associated with fragility after adjustment for age, gender, etiology of HF, left ventricular ejection fraction, New York Heart Association functional class, co-morbidities, and HF treatment, in both younger and older patients (p 0.001). In conclusion, MLWHFQ, a specific HF QoL questionnaire, is significantly influenced by fragility regardless of age.

Soluble ST2 (sST2) provides important prognostic information in patients with heart failure (HF). How sST2 serum concentration is related to renal function is uncertain. We evaluated the association between sST2 and renal function and compared its prognostic value in HF patients with renal insufficiency.Patients (n = 879; median age 70.4 years; 71.8% men) were divided into 3 subgroups according to estimated glomerular filtration rate (eGFR): ≥60 mL/min/1.73 m(2) (n = 337); 30-59 mL/min/1.73 m(2) (n = 352); and30 mL/min/1.73 m(2) (n = 190). sST2 (rho = -0.16; P .001), N-terminal pro-B-type natriuretic peptide (rho = -0.40; P.001), and high-sensitivity cardiac troponin T (rho = -0.47; P.001) inversely correlated with eGFR. All-cause mortality was the primary end point. During a median follow-up of 3.46 years, 312 patients (35%) died, 246 of them from the subgroup of 542 patients with eGFR60 mL/min/1.73 m(2) (45%). Biomarker combination including sST2 showed best discrimination, calibration, and reclassification metrics in renal insufficiency patients (net reclassification improvement 16.6 [95% confidence interval (CI) 8.1-25; P.001]; integrated discrimination improvement 4.2 [95% CI 2.2-6.2; P.001]). Improvement in reclassification was higher in these patients than in the total cohort.The prognostic value of sST2 was not influenced by renal function. On top of other biomarkers, sST2 improved long-term prediction in patients with renal insufficiency even more than in the total cohort.

Background This study was designed to assess whether depression and the use of antidepressants were related to long-term mortality in heart failure. Methods Heart failure outpatients (n=1017) from a specialized tertiary unit in Spain were prospectively studied for a median follow-up of 5.4years (IQR 3.1–8.1). Depressive symptoms were assessed using an abbreviated version of the geriatric depression scale. Survival rates during the study period (August 2001 until December 2010) and hazard ratios (HR) for mortality were adjusted by several demographic and clinical variables. Results Depressive symptoms were detected in 302 patients (29.7%) at baseline and 222 (21.8%) de novo during follow-up; 304 patients (29.9%) received at least one prescription of antidepressants, mainly selective serotonin reuptake inhibitors (92.8%); 441 patients (43.4%) died. In a multivariate Cox proportional hazard model, depression was associated with an increased all-cause (HR, 1.39; 95% CI, 1.15–1.68), but not cardiovascular, mortality risk after adjustment for several demographic and clinical confounders. The use of any antidepressant was not independently associated with mortality (HR, 0.89; 95% CI, 0.71–1.13), but benzodiazepines showed a protective role (HR, 0.70; 95% CI, 0.57–0.87). On the contrary, fluoxetine prescriptions, but not duration of fluoxetine treatment, were associated with increased mortality (HR, 1.66; 95% CI, 1.13–2.44). Conclusions Depressive symptoms are associated with long-term mortality, but the use of antidepressants and benzodiazepines is safe regarding survival in HF patients, although further research is needed considering individual antidepressants separately.

Aims Heart failure (HF) is a chronic condition that typically affects a patient's quality of life (QoL). Little is known about long-term QoL monitoring in HF. This study aimed to evaluate the temporal changes and prognostic value of QoL assessment in a real-life cohort of HF patients. Methods and results The Minnesota Living with Heart Failure Questionnaire was used to monitor QoL at baseline and at 1, 3, and 5 years for 1151 consecutive patients {71.7% men, median age 69 years [25th–75th percentiles (P25–P75) 59–76]} in an HF unit. Follow-up for prognosis assessment was extended to 6 years. The number of answered questionnaires was 1151 at baseline, 746 at 1 year, 268 at 3 years, and 240 at 5 years. QoL scores showed a steep decrease (indicating QoL improvement) during the first year [29 (P25–P75 16–43) at baseline vs. 15 (P25–P75 8–27) at 1 year, P < 0.001], which was tempered, yet significant up to 5 years [12 (P25–P75 7–23) at 3 years vs. 10 (P25–P75 5–21) at 5 years, P = 0.012]. We recorded 457 deaths during follow-up. In a comprehensive multivariable Cox regression analysis, baseline QoL remained a significant prognosticator during follow-up [hazard ratio (HR)Cox for death 1.012, 95% confidence interval 1.006–1.018, P < 0.001]. QoL monitoring showed that a score increase ≥10% between consecutive assessments stratified high-risk patients within the next 12 months (P = 0.008). Conclusion Both baseline and follow-up QoL monitoring were useful for patient risk stratification in a real-life HF cohort. Worse QoL may warn of a worse prognosis. Widespread QoL monitoring in routine clinical practice is recommended.

Balance alteration is a risk factor for falls in elderly individuals that has physical, psychological and economic consequences. The objectives of this study are to evaluate the usefulness of an intervention utilizing the Nintendo™ Wii console in order to improve balance, thereby decreasing both the fear of falling as well as the number of falls, and to evaluate the correlation between balance as determined by the console and the value obtained in the Tinetti tests and the one foot stationary test. This is a controlled, randomized clinical trial of individual assignment, carried out on patients over 70 years in age, from five primary care centers in the city of Mataro (Barcelona). 380 patients were necessary for the intervention group that carried out the balance board exercises in 2 sessions per week for a 3 month period, and 380 patients in the control group who carried out their usual habits. Balance was evaluated using the Tinetti test, the one foot stationary test and with the console, at the start of the study, at the end of the intervention (3 months) and one year later. Quarterly telephone follow-up was also conducted to keep track of falls and their consequences. The study aimed to connect the community with a technology that may be an easy and fun way to assist the elderly in improving their balance without the need to leave home or join rehabilitation groups, offering greater comfort for this population and decreasing healthcare costs since there is no need for specialized personnel. Current Control Trial NCT02570178 .

Introduccion y objetivos La mortalidad de la insuficiencia cardiaca es similar o incluso superior a la de muchos canceres. Suele ocurrir por progresion de la enfermedad, aunque la muerte subita se ha descrito como una causa frecuente. El objetivo es evaluar la mortalidad y sus causas en una poblacion ambulatoria de pacientes con insuficiencia cardiaca de etiologia diversa tratados en una unidad especializada multidisciplinaria y analizar los factores asociados con ellas. Metodos Estudio de seguimiento de cohorte (mediana, 36 meses) de 960 pacientes (el 70,9% varones; mediana de edad, 69 anos; mayoritariamente de etiologia isquemica, con fraccion de eyeccion del 31% y en clase funcional fundamentalmente II y III). Resultados Se registraron 351 fallecimientos (36,5%): 230 de causa cardiovascular (65,5%), fundamentalmente por insuficiencia cardiaca (33,2%) y muerte subita (16%), 94 de causa no cardiovascular (26,8%), fundamentalmente neoplasias (10,5%) y procesos septicos (6,8%), y 27 (7,7%) de causa desconocida. Mostraron relacion independiente con la mortalidad: edad, sexo, clase funcional, fraccion de eyeccion, tiempo de evolucion, etiologia isquemica, diabetes mellitus, aclaramiento de creatinina, vasculopatia periferica, fragilidad y ausencia de tratamiento con inhibidores de la enzima de conversion de angiotensina o antagonistas de los receptores de la angiotensina II, bloqueadores beta, estatinas y antiagregantes. El factor principal asociado a muerte cardiovascular fue la etiologia isquemica. No hallamos ningun factor predictor claramente determinante de muerte subita. Conclusiones Aunque la mortalidad de los pacientes atendidos en una unidad especializada de insuficiencia cardiaca no fue baja, una cuarta parte fallecio de causa no cardiovascular. El principal factor asociado a muerte cardiovascular fue la etiologia isquemica. La muerte subita afecto solo al 5,8% de la poblacion.

Introduction and objectives. Heart failure mortality is similar to or even higher than that due to various cancers. It is usually associated with disease progression, though sudden death has also been reported as a frequent cause of mortality. The objectives of this study were to investigate mortality and its causes in outpatients with heart failure of different etiologies who were treated in a specialist multidisciplinary unit, and to identify associated factors. Methods. The follow-up cohort study (median duration, 36 months) involved 960 patients (70.9% male; median age, 69 years; ejection fraction, 31%; and the majority had an ischemic etiology and were in functional class II or III). Results. Overall, 351 deaths (36.5%) occurred: 230 due to cardiovascular causes (65.5%), mainly heart failure (33.2%) and sudden death (16%); 94 due to noncardiovascular causes (26.8%), mainly malignancies (10.5%) and septic processes (6.8%); and 27 (7.7%) due to unknown causes. Mortality was independently associated with age, sex, functional class, ejection fraction, time since symptom onset, ischemic etiology, diabetes, creatinine clearance rate, peripheral vascular disease, fragility, and the absence of treatment with an angiotensin-converting enzyme inhibitor or angiotensin-II receptor blocker, betablockers, statins or antiplatelet agents. The principal factor associated with cardiovascular death was an ischemic etiology. No factor studied clearly predicted sudden death. Conclusions. Even though mortality in patients treated at a specialist heart failure unit was not low, a quarter died from non-cardiovascular causes. The principal factor associated with cardiovascular death was an ischemic etiology. Only 5.8% of the study population experienced sudden death.

Introduccion y objetivos Los pacientes con insuficiencia cardiaca presentan un elevado grado de fragilidad y dependencia. Durante 1 ano de seguimiento, examinamos la relacion de la fragilidad y los sintomas depresivos con la mortalidad a 1 ano y con la hospitalizacion por insuficiencia cardiaca. Metodos Todos los pacientes fueron sometidos a una valoracion geriatrica que permitiria la deteccion de fragilidad y de sintomas depresivos. Se evaluo a 622 pacientes (el 72,5% varones; mediana de edad, 68 anos; el 92% se hallaba en clase II o III de la NYHA; la mediana de fraccion de eyeccion era del 30%). Resultados Fallecieron durante el seguimiento 60 (9,5%) pacientes, y 101 (16,2%) tuvieron que ser hospitalizados por insuficiencia cardiaca. Se detecto fragilidad en el 39,9% de los pacientes y sintomas depresivos en el 25,2%. La fragilidad (el 16,9 frente al 4,8%; p Conclusiones En el analisis univariable, la fragilidad y los sintomas depresivos mostraron una relacion significativa con la mortalidad a 1 ano; ademas, la fragilidad mostro una relacion significativa con la necesidad de hospitalizacion por insuficiencia cardiaca. Sin embargo, solo la fragilidad mostro un valor predictivo de mortalidad independiente de otras variables con fuerte influencia en el pronostico

The European Heart Failure Self-care Behaviour Scale (EHFScBS) has been developed for assessing patients' self-care level. We used it to assess our patients' self-care progress after a medium-term period of nurse education intervention. Patients and method: We prospectively studied 151 patients (111 men and 40 women, mean age 65.4 ± 11.9 years). All patients were evaluated twice with the EHFScBS: during the first visit to the Unit and after 1 year of nurse educational intervention. Results: Mean score obtained by our patients in the initial evaluation was 24.8 ± 7.6. In the second evaluation patients showed a significant ( p < 0.001) improvement in self-care behaviour (mean score 19.9 ± 5.7). Analyzing item by item of the scale, patients show improvement in all items except in four: “If I am short of breath, I take it easy”, “I take a rest during the day”, “I eat a low salt diet” and “I take my medication as prescribed”. Conclusions: Improvement in self-care behaviour, assessed with the EHFScBS, was achieved with nurse educational intervention in patients without previous heart failure education. However, in our population, this improvement was not obtained in one important aspect such is low salt diet compliance, although punctuation in this item was quite acceptable already initially.

Introduction and objectives. Heart failure patients have high levels of frailty and dependence. Our aim was to determine the impact of frailty and depressive symptoms on the 1-year mortality rate and the rate of hospitalization for heart failure during a follow-up period of 1 year. Methods. All patients underwent geriatric evaluation, and frailty and depressive symptoms were identified. The study included 622 patients (72.5% male; median age, 68 years; 92% in New York Heart Association class II or III; and median ejection fraction, 30%). Results. During follow-up, 60 patients (9.5%) died and 101 (16.2%) were hospitalized for heart failure. Overall, 39.9% of patients exhibited frailty, while 25.2% had depressive symptoms. There were significant associations between mortality at 1 year and the presence of frailty (16.9% vs 4.8%; P

Objetivo el medico de familia es el primer profesional de salud que puede actuar preventivamente sobre la poblacion anciana de riesgo. El objetivo de este estudio es evaluar la eficacia de una intervencion multifactorial tras la valoracion geriatrica integral (VGI) en terminos de morbimortalidad. Material y metodos ensayo clinico aleatorizado, con grupo control (GC), en personas mayores de 75 anos visitadas en las consultas de un centro de atencion primaria durante un periodo de 18 meses. Segun la VGI, se clasifico al anciano como fragil o no; en el grupo de intervencion (GI) los pacientes fragiles recibieron una intervencion personalizada, mientras que a los no fragiles se les ofrecio participar en una sesion grupal. Resultados participaron en el estudio 620 sujetos, el 49,7% aleatorizados al GI y el 50,3% al GC. Realizaron la visita de seguimiento 430 (69,4%) pacientes. En la visita final, los pacientes del GC mostraron un riesgo significativamente superior de depresion (Yesavage) que el GI (p = 0,048). Durante el seguimiento, el 13% del GI modifico su estado inicial de fragiles a no fragiles frente al 5% del GC, mientras que el 11 % del GI paso a ser nuevos pacientes fragiles frente al 22% del GC (p Conclusiones la intervencion se mostro efectiva al contener el numero de pacientes fragiles de nuevo diagnostico y al aumentar el numero de pacientes que revirtieron el proceso en el GI durante el seguimiento. La VGI resulta efectiva si se asocia a una intervencion.

La insuficiencia renal es un importante factor pronostico en pacientes con insuficiencia cardiaca. Para valorar la funcion renal se suelen utilizar las cifras de creatinina serica. Sin embargo, cifras normales pueden ocultar una insuficiencia renal establecida. Hemos evaluado el significado pronostico del aclaramiento de creatinina estimado (Cockcroft) en 235 pacientes con insuficiencia cardiaca y cifras de creatinina normales. Los pacientes con insuficiencia renal establecida (aclaramiento

Fundamento y objetivo: Valorar la prevalencia de fibrilacion auricular (FA) en pacientes con insuficiencia cardiaca de una unidad multidisciplinaria, analizar los factores asociados y evaluar su significacion pronostica. Pacientes y metodo: Se incluyo a 389 pacientes, 64 con FA en la primera visita. La media (desviacion estandar) de la edad fue 65,38 (10,77) anos; el 72,5% eran varones. La etiologia era isquemica en el 59,9%. La fraccion de eyeccion (FE) media era de 32,25% (13%). A los 2 anos conociamos la situacion vital de 377 (97%) pacientes (314 en ritmo sinusal [RS] y 63 en FA). Resultados: La prevalencia de FA era del 15,8% y se asociaba con mayor edad, sexo femenino, etiologias hipertensiva y valvular, mayor duracion de los sintomas, mejor FE, mayor diametro de la auricula izquierda, mayor grado de insuficiencia mitral y peor calidad de vida, pero no con la clase funcional de la New York Heart Association (NYHA). La mortalidad a los 2 anos (16,7%) era significativamente mayor en los pacientes con FA (el 33,3 frente al 18,4%; odds ratio = 2,20; intervalo de confianza del 95%, 1,21-4), aunque al ajustar por otras variables relevantes como la edad, el sexo, la clase funcional, la FE y la etiologia, la FA no se mantuvo como factor pronostico independiente. Las diferencias mas importantes de mortalidad ocurrian en la insuficiencia cardiaca de causa isquemica y por miocardiopatia dilatada. Conclusiones: La FA tuvo relacion, fundamentalmente, con la edad, la etiologia valvular e hipertensiva y un mayor diametro de la auricula izquierda. La mortalidad a los 2 anos era significativamente mayor en los pacientes con FA, aunque otros parametros como la edad y la clase funcional de la NYHA tenian mayor significacion pronostica.

Resumen Objetivos analizar las diferencias clinicas, terapeuticas y evolutivas entre los pacientes mayores y menores de 75 anos diagnosticados de insuficiencia cardiaca (IC). Pacientes y metodos pacientes atendidos en una unidad multidisciplinaria de IC (UMIC) de los que se disponia datos diagnosticos y terapeuticos y de mortalidad de un ano de seguimiento. Para analizar las diferencias existentes entre los 2 grupos de edad, se utiliza la prueba de la χ2, t de Student o Kruskal-Wallis, segun el tipo de variables y el ajuste a la normalidad (intervalo de confianza del 95%). Resultados se estudio a 323 pacientes, con una media ± desviacion estandar de edad de 64,9 ± 10,5 anos (35-85). El 73% en el momento de la primera visita eran varones; 57 eran ≥ 75 anos. No hay diferencias etiologicas de la IC entre ambos grupos. En el de mas edad habia mas mujeres (el 42,1 frente al 23,8%; p = 0,003) y eran mas prevalentes la patologia respiratoria (el 29,8 frente al 18,4%; p = 0,05) y la anemia (el 42,1 frente al 24,8%; p = 0,008). Mas pacientes ≥ 75 anos fueron tratados con inhibidores de la enzima de conversion de la angiotensina (IECA) o con antagonistas de los receptores de la angiotensina II (el 91,7 frente al 77,2%; p = 0,001), bloqueadores beta (el 81,6 frente al 49,3%; p 0,001) y estatinas (el 62,8 frente al 43,1%; p = 0,004). Mas pacientes ≥ 75 anos fueron tratados con hidralazina + nitratos (el 19,2 frente al 6,8%; p = 0,003) y amiodarona (el 36,8 frente al 16,9%; p = 0,001). Las dosis de carvedilol eran mas bajas en los mas ancianos: 14,6 ± 10,6 mg frente a 29,4 ± 18,4 mg, p Conclusiones las diferencias de tratamiento entre los pacientes ancianos y los mas jovenes con IC atendidos en una UMIC son evidentes en esta muestra, sobre todo en el empleo de bloqueadores beta. La mortalidad, como era predecible, fue significativamente mas elevada en los pacientes de 75 anos o mayores.

Resumen Introduccion la insuficiencia cardiaca es muy prevalente en la poblacion geriatrica. La disminucion de la calidad de vida es, junto con la elevada mortalidad y las frecuentes hospitalizaciones, una caracteristica habitual de este proceso. El cuestionario Minnesota Living With Heart Failure es el instrumento mas utilizado para valorarla en los trabajos de investigacion. Nuestro objetivo ha sido conocer, mediante ese cuestionario, la calidad de vida de una poblacion geriatrica atendida en una unidad de insuficiencia cardiaca. Material y metodos se evaluo a 196 pacientes en la primera visita (edad media ± desviacion estandar, 75,5 ± 4,6 anos). Se analiza la correlacion entre la puntuacion en el cuestionario y varios factores clinicos, como diversos parametros de una evaluacion geriatrica sistematica. Resultados la puntuacion media fue 30,6 ± 17,4. Se encontro una fuerte correlacion (p Conclusiones la aplicacion del cuestionario Minnesota Living With Heart Failure a una poblacion geriatrica con insuficiencia cardiaca ha mostrado puntuaciones relativamente bajas. El deterioro de la calidad de vida se ha correlacionado de forma muy significativa con la clase funcional, el numero de ingresos en el ano previo, el sexo femenino y la presencia de fragilidad.

Use of betablockers in elderly patients with congestive heart failure BACKGROUND AND OBJECTIVE: Few studies of betablockers (BB) have been performed specifically in older patients with congestive heart failure (CHF). We evaluated the characteristics of elderly patients with CHF treated with BB. Moreover, we assessed whether BB are associated with a better outcome in them. PATIENTS AND METHOD: We evaluated clinical and functional characteristics of patients aged ≥ 75 years with CHF treated with or without BB, with special interest being paid in the mortality. RESULTS: 47 out of 107 patients were treated with BB. Only in 3 it was necessary to withdraw BB. Patients treated with no BB were older, with a higher New York Heart Association (NYHA) class, more prevalent chronic obstructive pulmonary disease (COPD) and in poorer functional situation. In patients treated with BB, ischemic heart disease was more prevalent. Reasons for «no treatment with BB» were severe aortic stenosis (n = 2), severe mitral regurgitation (n = 9), asthma-COPD (n = 28), arterial disease (n = 16) and fragility (n = 9). 25% of the patients on BB reached the target dose. One-year mortality (5.7% vs 27.6%) and 2-year mortality (20.68% vs 60%) were both significantly lower (p = 0.01 and p = 0.002, respectively) in patients on BB.ONCLUSIONS: 44% of our elderly patients with CHF received BB with good tolerance. Patients

Background: Heart failure (HF) patients have a high degree of fragility and dependence from physical, cognitive and psychological points ofview, and are a mainly geriatric population.Aim: To detect the existence of fragility in all patients treated in a Heart Failure Unit and to evaluate age and sex differences.Methods: All patients underwent a basic geriatric evaluation to detect possible loss of autonomy for doing basic and instrumental activities,cognitive deterioration, emotional disturbance or social risk.Results: Three hundred sixty patients (mean age 65.2 years, 41.7% z70 years, 27.5% women) were evaluated. Fragility was detected in41.7% of patients, being more prevalent in patients z70 years (pb0.001) and in women (pb0.001). A Barthel Index b90 was found in 22.5%of patients and an anomalous OARS Scale was found in 18.3%. Pfeiffer test’s score was abnormal in 7.8% of patients. A positive depressionresponse in abbreviate GDS was observed in 29.7%. All items analysed were more prevalent in patients z70 years and in women, with theunexpected exception of depression symptoms that were as prevalent in younger as in older patients.Conclusion: Fragility is common in patients with heart failure, even in younger patients, and can be detected easily using standardisedgeriatric scales. Prevalence of fragility was significantly higher in older patients and in women, although the presence of depressionsymptoms was as prevalent in younger as in older patients.D 2004 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

Fundamento y objetivo La relacion entre la diabetes mellitus y la insuficiencia cardiaca no esta bien establecida. El objetivo del estudio ha sido analizar la prevalencia y el significado pronostico de la diabetes en una poblacion con insuficiencia cardiaca atendida en una unidad especializada, valorando la mortalidad y la necesidad de ingresar por insuficiencia cardiaca al ano de seguimiento. Pacientes y metodo Se ha estudiado a 362 pacientes (un 73% varones) con edad media (desviacion estandar) de 65,3 (10,9) anos. La fraccion de eyeccion media era de 32,2 (12,7%). La clase funcional de la New York Heart Association era I en el 5% de los casos, II en el 47%, III en el 43% y IV en el 5%. Resultados El 39,5% (n = 143) de los pacientes eran diabeticos. Durante el primer ano de seguimiento fallecieron 30 pacientes (8%) y 70 (19%) precisaron ingresar por insuficiencia cardiaca. La mortalidad a un ano fue del 5% en los no diabeticos y del 13,3% en los diabeticos (p = 0,005). El 13,2% de los no diabeticos requirio ingresar al menos una vez por insuficiencia cardiaca, hecho que sucedio en el 28,7% de los diabeticos (p Conclusiones La prevalencia de la diabetes en la poblacion con insuficiencia cardiaca estudiada fue elevada. La diabetes se relaciono con una mayor mortalidad y con mayor necesidad de ingresar por insuficiencia cardiaca.

Aim: To evaluate what is really achieved with nurse education in an outpatient heart failure population. Method: The answers obtained in a nurse questionnaire performed at the first visit to the Unit and at 1 year of follow-up were compared. The questionnaire was addressed to know how compliant patients were and how much they knew about their disease and their treatment. Results: Two hundred and ninety eight patients (219 men and 79 women) were evaluated. Baseline mean age was 65 years (35–86). At first visit only 30% knew and understood the performance of the heart; 56% at 1 year ( p < 0.001). Only 28% initially understood the disease; 55% at follow-up ( p < 0.001). Awareness of more than 3 worsening signs increased from 66.5% to 86.5% ( p < 0.001). Knowledge of the names of all the pills they were receiving increased from 33% to 44% ( p < 0.001), of the action of these pills from 24% to 44% ( p < 0.001), and of how to use nitroglycerine among patients with ischemic heart disease from 87% to 96% ( p < 0.001). Initially 63% monitored their weight only at the medical visit and 21% monitored it at least once a week; at 1 year these percentages were 16% and 39% respectively ( p < 0.001). At baseline 45% checked blood pressure only at the medical visit and 28.5% checked it at least once a week; at 1 year these percentages were 12% and 43% ( p < 0.001). Whereas no significant differences were found in sodium restricted diet compliance, exercise performance increased slightly although statistically significantly ( p = 0.01). The great majority of patients never or only very rarely smoked or drunk alcoholic beverages, both at first visit and at 1 year, although both habits increased slightly during follow-up. No significant differences in treatment compliance (92% vs. 88% were taking all the medications prescribed) were found. Conclusion: Nurse-guided education has changed self-care behaviour of patients with heart failure in several important aspects, as weight and blood monitoring, and has increased their knowledge and understanding of the disease and treatment. However, these improvements have not been reflected in a better compliance of treatment and sodium restricted diet. Such aspects need more and more work to obtain better results.

Introduccion y objetivos Evaluar el valor pronostico de las concentraciones de hemoglobina (Hb) en relacion con la mortalidad y con los ingresos hospitalarios por insuficiencia cardiaca (IC) al ano de la primera visita a la Unidad de IC. Pacientes y metodo Conocemos la situacion vital y los ingresos por IC al ano en 337 pacientes admitidos entre agosto de 2001 y marzo de 2003. Las concentraciones de Hb se recogieron en la primera visita. Resultados Fallecieron 28 (8%) pacientes y hubo 158 ingresos por IC en 66 pacientes. Los valores de Hb se asociaron con la mortalidad a 1 ano (pacientes vivos, 13,0 ± 1,7 g/dl; pacientes fallecidos, 11,6 ± 1,7 g/dl; p Conclusiones Los valores de Hb se asocian inversamente con la mortalidad y los ingresos por IC en el primer ano de seguimiento. La prevalencia de anemia en nuestra poblacion con IC es elevada y tiene valor pronostico independiente.

Introduction and objectives. To evaluate the prognostic significance of hemoglobin (Hb) levels in terms of 1year mortality and hospital admissions due to heart failure (HF) during the first year of follow-up after the first visit to an outpatient HF unit. Patients and method. Survival status and HF-related hospital admission rate at 1 year were analyzed for 337 patients admitted between August 2001 and March 2003. Plasma Hb level was measured at the first visit to the unit. Results. 28 patients (8%) died and there were 158 HFrelated hospital admissions in 66 patients. Plasma Hb level correlated strongly with survival at 1 year, and was 13.0±1.7 g/dL in patients who were alive after this time, versus 11.7±1.6 g/dL (P

Quality of life is an important end-point in heart failure studies, as well as mortality and hospitalization rates. The Minnesota Living With Heart Failure Questionnaire is the instrument used most widely to evaluate quality of life in research studies. We used this questionnaire to evaluate quality of life in a general population attended by a heart failure unit in Spain.326 patients seen for the first time at the unit were evaluated. We analyzed the relationship between the questionnaire score and different clinical and demographic factors.The median global score on the Minnesota Living With Heart Failure Questionnaire was relatively low (28). We found a strong correlation (P.001) between the score and functional class, sex (women had higher scores), and diabetes. We also found a correlation between the score and number of hospital admissions in the previous year (P.001), anemia (P.001) and etiology (P=.01), and a weak trend toward higher scores with increasing age (P=.04). The highest scores were observed in patients with valve disease disorders (43), and the lowest were seen in patients with alcoholic cardiomyopathy (20) and ischemic heart disease (24). We found no correlation with time of evolution of heart failure or with left ventricular ejection fraction.The scores on the Minnesota Living With Heart Failure Questionnaire in a general population attended by a heart failure unit in Spain were relatively low. However, we found a strong correlation between this score and functional class, and also between this score and number of admissions in the previous year. These results suggest that the questionnaire adequately reflects the severity of the disease.

Introduccion y objetivos La calidad de vida es, junto con la mortalidad y las hospitalizaciones, un objetivo importante en los estudios sobre insuficiencia cardiaca. El cuestionario «Minnesota Living With Heart Failure» es el instrumento mas extensamente utilizado para valorarla en los trabajos de investigacion. Nuestro objetivo ha sido conocer la calidad de vida mediante este cuestionario en una poblacion general atendida en una unidad de insuficiencia cardiaca. Pacientes y metodo Se evaluo a 326 pacientes en la primera visita. Hemos analizado la correlacion entre la puntuacion obtenida y diversos factores clinicos y demograficos. Resultados La puntuacion global fue relativamente baja (28). Encontramos una fuerte correlacion (p Conclusiones La aplicacion del «Minnesota Living With Heart Failure» a una poblacion general con insuficiencia cardiaca ha mostrado puntuaciones relativamente bajas. A pesar de ello, hemos encontrado una correlacion importante de la puntuacion obtenida con la clase funcional y con el numero de ingresos en el ano previo, lo que sugiere que el cuestionario refleja correctamente el grado de severidad de la enfermedad.

Fundamento y objetivo: La prevalencia de la anemia en la poblacion con insuficiencia cardiaca es elevada y se ha visto que guarda una clara relacion con su pronostico. El objetivo del estudio es analizar la prevalencia de anemia (hemoglobina inferior a 12 g/dl) en una poblacion con insuficiencia cardiaca, atendida en una unidad de insuficiencia cardiaca multidisciplinaria, y analizar la relacion de las cifras de hemoglobina con parametros demograficos, clinicos, bioquimicos y terapeuticos. Pacientes y metodo: Entre agosto de 2001 y febrero de 2003 asistimos a 330 pacientes (edad media [DE] de 68,0 [9,3] anos). Para el analisis estadistico se han utilizado la regresion lineal simple, la regresion lineal multiple y las pruebas de la *2, de la t de Student y de Kruskal-Wallis. Resultados: El 30% de los pacientes estaban anemicos. Existia una relacion significativa de las cifras de hemoglobina con la edad, el sexo, la etiologia de la insuficiencia cardiaca, la coexistencia de diabetes, la ausencia de tabaquismo, la clase funcional, la calidad de vida, las cifras de creatinina, urea y colesterol, el tratamiento con diureticos de asa y nitratos, y la ausencia de tratamiento con bloqueadores beta. Sorprendentemente, no existia relacion significativa entre la presencia de cifras bajas de hemoglobina y el tratamiento con inhibidores de la enzima conversiva de la angiotensina, antiagregantes ni anticoagulantes. Conclusiones: La prevalencia de anemia en una poblacion general con IC es elevada. Las cifras de hemoglobina han guardado relacion con diversos parametros como la edad, el sexo, la clase funcional y las cifras plasmaticas de urea y de colesterol.

Summary Background & aims Nutritional assessment may help to explain the incompletely understood obesity paradox in patients with heart failure (HF). Currently, obesity is usually identified by body mass index (BMI). Our objective was to assess the prognostic influence of undernourishment in HF outpatients. Methods Two published definitions of undernourishment were used to assess 214 ambulatory HF patients. Definition 1 included albumin, total lymphocyte count, tricipital skinfold (TS), subscapular skinfold, and arm muscle circumference (AMC) measurements (≥2 below normal considered undernourishment). Definition 2 included TS, AMC, and albumin (≥1 below normal considered undernourishment). Patients were also stratified by BMI and body fat percentage and followed for 2 years. All-cause death or HF hospitalization was the primary endpoint. Results Based on BMI strata, among underweight patients, 60% and 100% were undernourished by Definitions 1 and 2, respectively (31% and 44% among normal-weight, 4% and 11% among overweight, and 0% and 3% among obese patients, respectively, according to the two definitions). The most prevalent undernourishment type was marasmus-like (18% of the total cohort). Undernourishment by both definitions was significantly associated with lower event-free survival. Following multivariable analysis, age, NYHA functional class, NTproBNP, and undernourishment (hazard ratio [HR] 2.25 [1.11–4.56] and 2.24 [1.19–4.21] for Definitions 1 and 2, respectively) remained in the model. In this cohort, BMI and percentage of body fat did not independently predict 2-year event-free survival. Conclusions Nutritional status is a key prognostic factor in HF above and beyond BMI and percentage of body fat. Patients in normal BMI range and even in overweight and obese groups showed undernourishment. The high mortality observed in undernourishment, infrequent in high BMI patients, may help to partly explain the obesity paradox. Proper undernourishment assessment should become routine in patients with HF.

High-sensitivity assays for cardiac troponins have recently become available, increasing the value of troponins in heart failure (HF) prognostication. We head-to-head compared the prognostic significance of high-sensitivity cardiac troponin T (hs-cTnT) and sensitive-contemporary cardiac troponin I (sc-cTnI) in an outpatient HF population.We studied 876 patients, mainly of ischemic etiology (52.1%). Median left ventricular ejection fraction was 34%. Median follow-up was 3.45 years. Comprehensive statistical measurements of performance (discrimination, calibration, and reclassification) were obtained.hs-cTnT was ubiquitous in the patient cohort; sc-cTnI was detected in 276 patients (31.5%). During follow-up 311 patients died. According to multivariable Cox regression analysis, both hs-cTnT (HR 2.09, 95% CI 1.46-2.99, P0.001) and sc-cTnI (HR 1.61, 95% CI 1.24-2.08, P0.001) remained independent predictors of all cause and cardiovascular mortality. Using the best predictive cut-off point for both troponins calibration was better for hs-cTnT, which also reclassified a larger number of patients (NRI 9.0 [2.5;15.5] P = 0.007). The higher sensitivity of hs-cTnT permitted the identification of almost the double of deaths.Both hs-cTnT and sc-cTnI predict mortality in a real-life cohort of ambulatory HF patients. However, hs-cTnT showed globally better measures of performance and identified a higher proportion of decedents during follow-up.

To assess the relationship between statins and prognosis in ischemic and nonischemic patients with heart failure (HF) in a real-life cohort followed up for a long period.This prospective study included 960 patients with HF with preserved or depressed left ventricular ejection fraction (LVEF), irrespective of HF etiology, who were referred to the HF clinic of a university hospital between August 1, 2001, and December 31, 2008. The patients were followed up for a maximum of 9.1 years (median, 3.7 years), and survival in ischemic and nonischemic patients was determined.Median age was 69 years, and median LVEF was 31%. Of the 960 patients, 532 (55.4%) had ischemic HF etiology, and most received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (846; 88.1%) and β-blockers (776; 80.8%). Patients with HF of ischemic origin were more often treated with statins (P.001). During follow-up, 440 patients (45.8%) died. Statin therapy was associated with significantly improved survival (hazard ratio, 0.45 [95% confidence interval, 0.37-0.54]; P.001). After adjustment for HF prognostic factors (age, sex, cholesterol level, New York Heart Association class, HF etiology, LVEF, body mass index, HF duration, atrial fibrillation, implantable cardioverter-defibrillator therapy, and medicines), statins remained significantly associated with lower mortality risk in both ischemic (P=.007) and nonischemic (P=.002) patients.In contrast to results of large randomized trials, statins were independently and significantly associated with lower mortality risk in our real-life HF cohort, including patients with nonischemic HF etiology.

Obesity is paradoxically associated with survival in patients with heart failure (HF). Our objective was to assess whether the relationship between body mass index (BMI) and long-term survival is associated with HF etiology (ischemic vs. non-ischemic) in a cohort of ambulatory HF patients.BMI and survival status after a median follow-up of 6.1 years (IQR 2.2-7.8) were available for 504 patients (73% men; median age 68 years [IQR 58-74]). Fifty-nine percent of patients had ischemic etiology. Median left ventricular ejection fraction (LVEF) was 30% (IQR 23-39.7%). Most patients were in NYHA functional class II (51%) or III (42%). Patients were divided into four groups according to BMI: low weight (BMI20.5 kg/m(2)), normal weight (BMI 20.5 to25.5 kg/m(2)), overweight (BMI 25.5 to30 kg/m(2)), and obese (BMI ≥ 30 kg/m(2)).Mortality differed significantly across the BMI strata in non-ischemic patients (log-rank p0.0001) but not in ischemic patients. Using normal weight patients as a reference, hazard ratios for low weight, overweight, and obese patients were 2.08 (1.16-3.75, p = 0.014), 0.88 (0.54-1.43, p = 0.60), and 0.49 (0.28-0.86, p = 0.01), respectively, for non-ischemic patients and 1.19 (0.48-2.97, p = 0.71), 0.88 (0.61-1.27, p = 0.48), and 0.96 (0.66-1.41, p = 0.85), respectively, for ischemic patients. After adjusting for age, sex, NYHA functional class, LVEF, co-morbidities, and treatment, BMI remained an independent predictor of survival in non-ischemic patients.Over long-term follow-up of ischemic and non-ischemic HF, the obesity paradox was only observed in patients with non-ischemic HF.

Objective. To assess the effectiveness of an intervention after comprehensive geriatric assessment (CGA) in reducing morbidity and mortality in patients over 74 years in primary care. Methods. Randomized controlled trial with 18 months of follow-up. Patients in the control group (CG) followed usual care. Patients in the intervention group (IG) were classified as at risk or non-risk of frailty based on the CGA. Patients at non-risk of frailty in the IG were provided with recommendations about healthy habits and adherence to treatment in group sessions, while patients at risk of frailty were visited individually by a geriatrician. Results. Six hundred and twenty patients were randomized to the IG (49.7%) or to the CG (50.3%), 83.2% completed follow-up. Cox’s proportional hazards model showed as covariates the study group (hazard ratio [HR] 0.58; 95% confidence interval [CI] 0.28–1.22), risk of frailty (HR 1.33; 95% CI 0.71–2.51) and the interaction between both (HR 3.08; 95% CI 1.22–7.78). Forty-nine percent of the patients in the IG and 43% in the CG were at risk of frailty at baseline. At the end of the study, 27.9% of the IG and 13.5% of the CG had reversed their initial at risk of frailty status (P = 0.027). Multivariate predictors of reversible risk of frailty were younger age, not being at risk of depression, low consumption of medications and the intervention itself. Conclusions. A specific intervention in patients over 74 years attended in primary care reduces morbidity and mortality in patients at risk of frailty and increases the proportion of patients that reversed their initial status at risk of frailty.

the family doctor is in a unique position to prevent complications in the elderly population. The aim of this study was to evaluate the efficacy of a multifactorial intervention in reducing morbidity and mortality after a global geriatric assessment (GGA) was performed.a randomized clinical trial with a control group was carried out in elderly patients aged more than 75 years old visited in the primary care setting over a 18-month period. An individualized intervention was applied to all patients in the intervention group (IG) identified as frail by the GGA. A group session was offered to the remaining patients in the IG.there were 620 participants: 49.7% were randomized to the IG and 50.3% to the control group (CG). Follow-up was completed by 430 (69.4%) participants. At the end of the study, the CG showed a significantly greater risk of depression (Yesavage) than the IG (P=.048). During the follow-up, 13% of the IG and 5% of the CG changed their initial status of frailty to one of non-frailty, while 11% of the IG and 22% of the CG were newly diagnosed as frail (P.001). The total number of events (nursing home admission, home visits, deaths) was 15% in the IG and 17% in the CG (P=.64).the intervention proved to be effective in containing the number of patients newly diagnosed as frail and in increasing the number of participants who reversed their status from frail to non-frail during the follow-up. GGA is effective if used in conjunction with an intervention.

Kidney failure is an important prognostic factor in patients with heart failure. Renal function is usually evaluated by measuring the serum creatinine level. However, a normal creatinine level can mask established kidney failure. We investigated the prognostic significance of the estimated creatinine clearance rate (Cockcroft formula) in 235 patients with heart failure and a normal serum creatinine level. The two-year mortality rate was significantly higher in patients who had established kidney disease (i.e., a creatinine clearance rate60 mL/min) than in those who did not (35.1% vs. 10.1%, P.001). Even when only patients without established kidney failure were analyzed, the creatinine clearance rate had prognostic significance (rateor = 90 mL/min, mortality 3.2%; rate 89-60 mL/min, mortality 13.9%; P=.02). On Cox regression analysis, which included age, sex, heart failure etiology, left ventricular ejection fraction, diabetes and hypertension, the creatinine clearance rate remained an independent predictor of mortality.

We aimed to assess the prevalence of atrial fibrillation (AF) in a general heart failure (HF) population admitted to a HF unit, analyze the parameters associated with AF, and evaluate its prognostic significance.389 patients, 64 with AF at the first visit. Mean (SD) age was 65.38 (10.77) years and 72.5% were men. The main etiology was ischemic heart disease (59.9%). Mean ejection fraction (EF) was 32.25% (13%). Vital status at 2 years was available in 377 patients (97%), 314 in sinus rhythm (SR) and 63 in AF.The prevalence of AF was 15.8%. AF was associated with: older age, female gender, valvular and hypertensive etiology, longer time since the onset of HF symptoms, higher EF, higher left atrium diameter, degree of mitral regurgitation, and lower quality of life, but not with the NYHA functional class. The 2-years mortality (16.7%) was significantly higher in patients with AF (33.3% vs 18.4%; OR = 2.20; 95% confidence interval, 1.21-4). However, when adjusted for other relevant variables such as age, NYHA functional class, ejection fraction, sex and etiology, AF did not remain as an independent prognostic factor. The strongest mortality differences between patients with AF and those with SR where observed in ischemic heart disease and dilated cardiomyopathy.AF was associated mainly with age, valvular and hypertensive etiology, higher left atrium diameter and lower end-systolic left ventricular diameter. Two years mortality was significantly higher in patients with AF, although other parameters such as age and NYHA functional class had a higher prognostic value.

Few studies of betablockers (BB) have been performed specifically in older patients with congestive heart failure (CHF). We evaluated the characteristics of elderly patients with CHF treated with BB. Moreover, we assessed whether BB are associated with a better outcome in them.We evaluated clinical and functional characteristics of patients agedor = 75 years with CHF treated with or without BB, with special interest being paid in the mortality.47 out of 107 patients were treated with BB. Only in 3 it was necessary to withdraw BB. Patients treated with no BB were older, with a higher New York Heart Association (NYHA) class, more prevalent chronic obstructive pulmonary disease (COPD) and in poorer functional situation. In patients treated with BB, ischemic heart disease was more prevalent. Reasons for "no treatment with BB" were severe aortic stenosis (n = 2), severe mitral regurgitation (n = 9), asthma-COPD (n = 28), arterial disease (n = 16) and fragility (n = 9). 25% of the patients on BB reached the target dose. One-year mortality (5.7% vs 27.6%) and 2-year mortality (20.68% vs 60%) were both significantly lower (p = 0.01 and p = 0.002, respectively) in patients on BB.44% of our elderly patients with CHF received BB with good tolerance. Patients treated with BB were younger, with more ischemic heart disease, better NYHA class, less functional deterioration and without COPD. One-year and two-year mortality in patients who can receive BB were lower.

The relationship between diabetes mellitus and heart failure is not fully established. The aim of the study was to assess the prevalence of diabetes and its prognostic significance, considering mortality and the need of hospital admission due to heart failure during the first year of follow-up, in an outpatient population with heart failure attended in a specialized Unit.We studied 362 patients -73% men; mean age (standard deviation) 65.3 (10.9) years-. Mean ejection fraction was 32.2% (12.7%). Patients were in New York Heart Association functional class I (5%), II (47%), III (43%) and IV (5%).One-hundred forty-three out of 362 patients were diabetic (39.5%). Thirty patients (8%) died and 70 (19%) needed to be hospitalized due to heart failure during the first year of follow-up. One year mortality was 5% in non-diabetic patients and 13.3% in diabetic patients (p = 0.005). 13.2% of non-diabetic patients suffered at least one episode of heart failure needing hospital admission, whereas 28.7% of diabetic patients needed to be hospitalized at least once (p0.001). In the multivariate regression analysis, diabetes remained statistically associated both with mortality and with the need of heart failure related hospital admission.Diabetes significantly correlated with a higher one year mortality as well as with a greater need of hospital admission due to heart failure. Prevalence of diabetes in a general population with heart failure was high.

Introduction and objectives. Heart failure leads to frequent hospital readmissions. The aim of this study was to assess how receiving attention at our multidisciplinary unit influenced hospitalization for heart failure. We compared the number of admissions in the year preceding attendance with that in the first year of follow-up. Patients and method. In total, 366 patients were admitted between August 2001 and June 2003. Of these, 332 were still alive and could be assessed clinically 1 year later. The most common etiologies were ischemic heart disease in 60%, and dilated cardiomyopathy in 10%. Results. The number of admissions in the year preceding attendance was 246, while that during the first year of follow-up was 125, which corresponds to a statistically significant reduction of 49% (P

There is a high prevalence of anemia in patients with heart failure which is related to their outcome. The aim of the study was to evaluate the prevalence of anemia (haemoglobin12 g/dl) in patients attended in a Multidisciplinary Heart Failure Unit and to analyze the correlation of hemoglobin levels and the presence of anemia with demographic, clinic, biological and therapeutic parameters.Between August 2001 and February 2003, 330 patients were attended (mean age [SD], 68.0 [9.3] years). Simple lineal regression, multiple lineal regression, *2 test, Student t test and Kruskal-Wallis test were used for statistical analysis.30% patients had anemia. We found a significant correlation between plasmatic hemoglobin levels and age, gender, etiology of heart failure, coexistence of diabetes, absence of smoking habit, functional class, quality of life, plasmatic levels of urea, creatinine and cholesterol, treatment with diuretics and nitrates and the absence of treatment with betablockers. Surprisingly, there was no relationship between treatment with angiotensin-converting enzyme inhibitors, antiplatelet drugs or anticoagulants and the presence of low levels of hemoglobin.The prevalence of anemia in a general population with heart failure is high. Plasmatic hemoglobin levels were related to several parameters, mainly age, gender, functional class and plasmatic levels of urea and cholesterol.