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Cardiorenal clinics; Cardiorenal disease; Cardiorenal program Clínicas cardiorrenales; Enfermedad cardiorrenal; Programa cardiorrenal Clíniques cardiorenals; Malaltia cardiorenal; Programa cardiorenal The population with concomitant heart and kidney disease (often termed ‘cardiorenal’ disease) is expected to grow, significantly impacting public health and healthcare utilization. Moreover, the cardiorenal nexus encompasses a bidirectional relationship that worsens prognosis and may complicate pharmacological management in often elderly and frail patients. Therefore, a more cohesive multidisciplinary team approach aiming to provide holistic, coordinated and specialized care would be a positive shift towards improving patient outcomes and optimizing healthcare resources. This article aims to define the organizational aspects and key elements for setting up a multidisciplinary cardiorenal clinical program as a potential healthcare model adapted to the particular characteristics of patients with cardiorenal disease.

Cardiorenal syndrome; Chronic renal failure; Diuretics Síndrome cardiorrenal; Insuficiencia renal crónica; Diuréticos Síndrome cardiorenal; Insuficiència renal crònica; Diürètics Cardiorenal syndrome (CRS) is a complex disease in which the heart and kidneys are simultaneously affected, and subsequently, the malfunction of one organ promotes the deterioration of the other. Heart failure (HF) with preserved ejection fraction (HFpEF) is the most common form of HF. The pathophysiology of CRS is not well known and several mechanisms have been proposed. An elevation of central venous pressure seems to be one of the key points to consider, among others such as an increase in intraabdominal pressure. Several diagnostic tools have been identified to establish the diagnosis of CRS in patients with HFpEF. Currently, the availability of biomarkers of renal and cardiac injury, the use of pulmonary ultrasound, the monitoring of the size of the inferior vena cava and the study of the renal venous pattern offer a new dimension in accurately diagnosing and quantifying organ damage in CRS. Beyond the symptomatic treatment of congestion, until recently specific therapeutic tools for patients with CRS and HFpEF were not available. Interestingly, the development of new drugs such as the angiotensin/neprilysin inhibitors and sodium-glucose cotransporter-2 (SGLT-2) inhibitors offer new therapeutic strategies with potential benefits in reduction of cardiorenal adverse outcomes in this population. Randomized clinical trials that focus on patients with HFpEF are currently ongoing to delineate optimal new treatments that may be able to modify their prognosis. In addition, multidisciplinary teamwork (nephrologist, cardiologist and nurse) is expected to decrease the number of visits and the rate of hospitalizations, with a subsequent patient benefit.

Advanced heart failure; Inotropes; Palliative care Insuficiencia cardiaca avanzada; Inotropos; Cuidados paliativos Insuficiència cardíaca avançada; Inòtrops; Cures pal·liatives Aim Patients with advanced heart failure (AHF) who are not candidates to advanced therapies have poor prognosis. Some trials have shown that intermittent levosimendan can reduce HF hospitalizations in AHF in the short term. In this real-life registry, we describe the patterns of use, safety and factors related to the response to intermittent levosimendan infusions in AHF patients not candidates to advanced therapies. Methods and results Multicentre retrospective study of patients diagnosed with advanced heart failure, not HT or LVAD candidates. Patients needed to be on the optimal medical therapy according to their treating physician. Patients with de novo heart failure or who underwent any procedure that could improve prognosis were not included in the registry. Four hundred three patients were included; 77.9% needed at least one admission the year before levosimendan was first administered because of heart failure. Death rate at 1 year was 26.8% and median survival was 24.7 [95% CI: 20.4–26.9] months, and 43.7% of patients fulfilled the criteria for being considered a responder lo levosimendan (no death, heart failure admission or unplanned HF visit at 1 year after first levosimendan administration). Compared with the year before there was a significant reduction in HF admissions (38.7% vs. 77.9%; P < 0.0001), unplanned HF visits (22.7% vs. 43.7%; P < 0.0001) or the combined event including deaths (56.3% vs. 81.4%; P < 0.0001) during the year after. We created a score that helps predicting the responder status at 1 year after levosimendan, resulting in a score summatory of five variables: TEER (+2), treatment with beta-blockers (+1.5), Haemoglobin >12 g/dL (+1.5), amiodarone use (−1.5) HF visit 1 year before levosimendan (−1.5) and heart rate >70 b.p.m. (−2). Patients with a score less than −1 had a very low probability of response (21.5% free of death or HF event at 1 year) meanwhile those with a score over 1.5 had the better chance of response (68.4% free of death or HF event at 1 year). LEVO-D score performed well in the ROC analysis. Conclusion In this large real-life series of AHF patients treated with levosimendan as destination therapy, we show a significant decrease of heart failure events during the year after the first administration. The simple LEVO-D Score could be of help when deciding about futile therapy in this population.

Insuficiència cardíaca crònica amb fracció d’ejecció reduïda; Vericiguat; Tractament Insuficiencia cardíaca crónica con fracción de eyección reducida; Vericiguado; Tratamiento Chronic heart failure with reduced ejection fraction; Vericiguat; Treatment La insuficiència cardíaca (IC) és una síndrome clínica caracteritzada per una sèrie de símptomes (dificultat respiratòria, edema mal·leolar i fatiga) que poden anar acompanyats de signes (augment de la pressió venosa jugular, crepitants pulmonars i edemes perifèrics) produïda per alteracions cardíaques funcionals i/o estructurals. Els objectius del tractament de la IC són prolongar la supervivència, disminuir els ingressos hospitalaris i millorar els símptomes i la qualitat de vida.

Dapagliflozin; Empagliflozin; Heart failure Dapagliflozina; Empagliflozina; Atac de cor Dapagliflozina; Empagliflozina; Insuficiencia cardiaca The role of sodium-glucose cotransporter 2 inhibitors (SLTG2i), developed initially as glucose-lowering agents, has represented a novelty in patients with heart failure (HF) and reduced ejection fraction (HFrEF) since dapagliflozin (DAPA-HF study) and empagliflozin (EMPEROR-Reduced study) were able to reduce morbidity and mortality in this setting regardless of the presence or absence of diabetes. In previous large clinical trials (EMPA-REG OUTCOME study, CANVAS, DECLARE-TIMI 58), SGLT2i have been shown to attenuate HF progression expressed by reducing the risk of HF hospitalizations in patients with type 2 diabetes mellitus mostly without HF at baseline. This benefit was then corroborated with positive results in HF outcomes (cardiovascular mortality and HF hospitalizations) in patients with HF with preserved ejection fraction (HFpEF) in the EMPEROR-Preserved (empagliflozin) and DELIVER (dapagliflozin) trials. Several biological mechanisms apart from the glycosuria are attributed to these agents in this last context, including anti-inflammatory effects, reduction of fibrosis and apoptosis, improvement of myocardial metabolism, mitochondrial function optimization, and oxidative stress protection. Moreover, SGLT2i can also improve ventricular loading conditions by forcing diuresis and natriuresis, and by enhancing vascular and renal function. In addition, SGLT2i can reduce myocardial passive stiffness (diastolic function) by enforcing the phosphorylation of myofilament modulatory proteins. This article provided an overview of the main pathophysiological characteristics of HFpEF and of the diverse mechanisms of action of SGLT2i in this setting. The supporting clinical evidence of SGLT2i in HFpEF (EMPEROR-Preserved and DELIVER trials) is also reviewed. This article is part of the Emerging concepts in heart failure management and treatment Special Issue: https://www.drugsincontext.com/special_issues/emerging-concepts-in-heart-failure-management-and-treatment.

Diabetes; Insuficiencia cardíaca; Tratamiento nutricional Diabetis; Insuficiència cardíaca; Tractament nutricional Diabetes; Heart failure; Medical nutrition La insuficiencia cardíaca (IC) es una de las principales causas de morbilidad y mortalidad entre las personas mayores, lo que la convierte en un importante problema de salud pública. Las enfermedades cardiovasculares en general, y la IC en particular, son comorbilidades frecuentes en personas con diabetes tipo 2 (DM2). La presencia de DM2 e IC se asocia con síntomas y signos clínicos más graves, y peor calidad de vida y pronóstico. Además, debido al estado hipercatabólico y los trastornos de la absorción de nutrientes, la desnutrición está presente en muchos casos de IC. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con IC. Heart failure (HF) is one of the leading causes of morbidity and mortality among older people, making it a major public health problem. Cardiovascular diseases in general, and HF in particular, are common comorbidities in people with type 2 diabetes (DM2). The concurrence of DM2 and HF is associated with more severe clinical symptoms and signs, and poorer quality of life and prognosis. Furthermore, due to the hypercatabolic state and nutrient absorption disorders, malnutrition is present in many HF cases. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with HF.

Insuficiencia cardíaca; Función ventricular; Tratamiento farmacológico; Atención primaria de salud Insuficiència cardíaca; Funció ventricular; Tractament farmacològic; Atenció primària de salut Heart failure; Ventricular function; Pharmacotherapy; Primary health care Despite better diagnoses and treatments, heart failure (HF) is an important cause of death in Spain. The objective of this study is to describe the characteristics and treatment of a population with chronic HF classified according to the left ventricular ejection fraction (LVEF). Population-based observational cohort study in Primary Health Care. Catalonia, Spain, during 2014–2018. Adults with HF classified by the LVEF. Analysis of electronic health data registered in SIDIAP (Information System for Research in Primary Care). Demographics, LVEF, comorbidities, and use of drugs for HF. 10,130 patients were included; 18.9% with LVEF

Childhood hypertrophic cardiomyopathy; Outcomes; Phenotype Miocardiopatía hipertrófica infantil; Resultados; Fenotipo Miocardiopatia hipertròfica infantil; Resultats; Fenotip Background Up to one-half of childhood sarcomeric hypertrophic cardiomyopathy (HCM) presents before the age of 12 years, but this patient group has not been systematically characterized. Objectives The aim of this study was to describe the clinical presentation and natural history of patients presenting with nonsyndromic HCM before the age of 12 years. Methods Data from the International Paediatric Hypertrophic Cardiomyopathy Consortium on 639 children diagnosed with HCM younger than 12 years were collected and compared with those from 568 children diagnosed between 12 and 16 years. Results At baseline, 339 patients (53.6%) had family histories of HCM, 132 (20.9%) had heart failure symptoms, and 250 (39.2%) were prescribed cardiac medications. The median maximal left ventricular wall thickness z-score was 8.7 (IQR: 5.3-14.4), and 145 patients (27.2%) had left ventricular outflow tract obstruction. Over a median follow-up period of 5.6 years (IQR: 2.3-10.0 years), 42 patients (6.6%) died, 21 (3.3%) underwent cardiac transplantation, and 69 (10.8%) had life-threatening arrhythmic events. Compared with those presenting after 12 years, a higher proportion of younger patients underwent myectomy (10.5% vs 7.2%; P = 0.045), but fewer received primary prevention implantable cardioverter-defibrillators (18.9% vs 30.1%; P = 0.041). The incidence of mortality or life-threatening arrhythmic events did not differ, but events occurred at a younger age. Conclusions Early-onset childhood HCM is associated with a comparable symptom burden and cardiac phenotype as in patients presenting later in childhood. Long-term outcomes including mortality did not differ by age of presentation, but patients presenting at younger than 12 years experienced adverse events at younger ages. This work was supported by the British Heart Foundation (grant FS/16/72/32270) to Drs Norrish and Kaski. This work is (partly) funded by the National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre. Dr Norrish is supported by Great Ormond Street Hospital Children’s Charity. Drs Field and Kaski are supported by Max’s Foundation and Great Ormond Street Hospital Children’s Charity. Dr Kaski is supported by a Medical Research Council–National Institute for Health Research Clinical Academic Research Partnership award. This work was financially supported by the Foundation for Paediatric Research of Finland (Dr Ojala). Dr Fernandez has received speaker fees from Sanofi-Genzyme. Dr Kubus is supported by MH CZ – DRO, Motol University Hospital (00064203). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Calpain; Calpastatin; Myocardial hypertrophy Calpaína; Calpastatina; Hipertrofia miocárdica Calpaïna; Calpastatina; Hipertròfia miocàrdica Despite advances in its treatment, heart failure remains a major cause of morbidity and mortality, evidencing an urgent need for novel mechanism-based targets and strategies. Myocardial hypertrophy, caused by a wide variety of chronic stress stimuli, represents an independent risk factor for the development of heart failure, and its prevention constitutes a clinical objective. Recent studies performed in preclinical animal models support the contribution of the Ca2+-dependent cysteine proteases calpains in regulating the hypertrophic process and highlight the feasibility of their long-term inhibition as a pharmacological strategy. In this review, we discuss the existing evidence implicating calpains in the development of cardiac hypertrophy, as well as the latest advances in unraveling the underlying mechanisms. Finally, we provide an updated overview of calpain inhibitors that have been explored in preclinical models of cardiac hypertrophy and the progress made in developing new compounds that may serve for testing the efficacy of calpain inhibition in the treatment of pathological cardiac hypertrophy. This study was funded by the Instituto de Salud Carlos III of the Spanish Ministry of Health FIS-PI20/01681) and the research network CIBERCV (CB16/11/00479).

Dispnea; Sibilàncies; Tos; Insuficiència cardíaca aguda; Broncodilatadors Disnea; Sibilancias; Tos; Insuficiencia cardíaca aguda; Broncodilatadores Dyspnoea; Wheezing; Cough; Acute heart failure; Bronchodilators Essencial és una iniciativa que identifica pràctiques clíniques de poc valor i promou recomanacions per tal d'evitar-ne la realització. En aquest document es parla sobre el tractament en pacients amb dispnea, sibilàncies o tos per insuficiència cardíaca aguda sense malaltia pulmonar obstructiva crònica o asma.

HL-1 cells; L-type calcium channels; Calcium regulation Células HL-1; Canales de calcio tipo L; Regulación del calcio Cel·lules HL-1; Canals de calci tipus L; Regulació del calci MicroRNAs (miRNAs) participate in atrial remodeling and atrial fibrillation (AF) promotion. We determined the circulating miRNA profile in patients with AF and heart failure with reduced ejection fraction (HFrEF), and its potential role in promoting the arrhythmia. In plasma of 98 patients with HFrEF (49 with AF and 49 in sinus rhythm, SR), differential miRNA expression was determined by high-throughput microarray analysis followed by replication of selected candidates. Validated miRNAs were determined in human atrial samples, and potential arrhythmogenic mechanisms studied in HL-1 cells. Circulating miR-199a-5p and miR-22-5p were significantly increased in HFrEF patients with AF versus those with HFrEF in SR. Both miRNAs, but particularly miR-199a-5p, were increased in atrial samples of patients with AF. Overexpression of both miRNAs in HL-1 cells resulted in decreased protein levels of L-type Ca2+ channel, NCX and connexin-40, leading to lower basal intracellular Ca2+ levels, fewer inward currents, a moderate reduction in Ca2+ buffering post-caffeine exposure, and a deficient cell-to-cell communication. In conclusion, circulating miR-199a-5p and miR-22-5p are higher in HFrEF patients with AF, with similar findings in human atrial samples of AF patients. Cells exposed to both miRNAs exhibited altered Ca2+ handling and defective cell-to-cell communication, both findings being potential arrhythmogenic mechanisms. This work was funded by the following grants, awarded to B.B.: Sociedad Española de Cardiología, Sección de Arritmias y Electrofisiología 2012; Sociedad Española de Cardiología, Sección de Insuficiencia Cardíaca 2013; Fondo Investigación Sanitaria (FIS)—Instituto Carlos III 2013 (PI13/01830); and Societat Catalana de Cardiologia 2016. Awarded to K.W.A-A. and S.R.: British Heart Foundation (BHF) Intermediate Research Fellowship. Awarded to J.M.F.F.: grant from the Spanish Ministry of Science and Innovation (RTI2018-094809-B-I00). “María de Maeztu” Programme for Units of Excellence in R&D to the Departament de Ciències Experimentals i de la Salut (MDM-2014-0370) and FEDER (Fondo Europeo de Desarrollo Regional) also contributed to this work.

Dapagliflozina; ISGLT2; Insuficiència cardíaca crònica; Fracció ejecció reduïda Dapagliflozina; ISGLT2; Insuficiencia cardíaca crónica; Fracción eyección reducida Dapagliflozin; ISGLT2; Chronic heart failure; Reduced ejection fraction La insuficiència cardíaca (IC) és una síndrome clínica caracteritzada per una sèrie de símptomes (dificultat respiratòria, edema mal·leolar i fatiga) que poden anar acompanyats de signes (augment de la pressió venosa jugular, crepitants pulmonars i edemes perifèrics) produïda per alteracions cardíaques funcionals i/o estructurals.1 La classificació de la IC es basa principalment en la fracció d’ejecció del ventricle esquerre (FEVE). Es considera IC amb FEVE reduïda quan aquesta és igual o inferior al 40% i representa aproximadament un 50% del total de casos d’IC en el nostre entorn.La causa principal d’aquesta és la malaltia coronària, tot i que altres factors de risc, com la hipertensió arterial, la diabetis mellitus o la síndrome metabòlica, també hi contribueixen. La identificació de la causa subjacent ha de ser part del diagnòstic ja que condiciona el pronòstic i el tractament. La insuficiencia cardiaca (IC) es un síndrome clínico caracterizado por una serie de síntomas (dificultad respiratoria, edema maleolar y fatiga) que pueden ir acompañados de signos (aumento de la presión venosa yugular, crepitantes pulmonares y edemas periféricos) producida por alteraciones cardíacas funcionales y / o estructurals.1 La clasificación de la IC se basa principalmente en la fracción de eyección del ventrículo izquierdo (FEVE). Se considera IC con FEVE reducida cuando ésta es igual o inferior al 40% y representa aproximadamente un 50% del total de casos de IC en nuestro entorn.La causa principal de esta es la enfermedad coronaria, aunque otros factores de riesgo, como la hipertensión arterial, la diabetes mellitus o el síndrome metabólico, también contribuyen. La identificación de la causa subyacente debe ser parte del diagnóstico ya que condiciona el pronóstico y el tratamiento. Heart failure (HF) is a clinical syndrome characterized by a number of symptoms (difficulty breathing, malleolar edema, and fatigue) that may be accompanied by signs (increased jugular venous pressure, pulmonary crackling, and peripheral edema) caused by alterations. functional and / or structural cardiac disorders.1 The classification of HF is mainly based on the left ventricular ejection fraction (FEVE). It is considered HF with reduced FEVE when it is equal to or less than 40% and represents approximately 50% of all cases of HF in our environment. The main cause of this is coronary heart disease, although other factors of risk, such as high blood pressure, diabetes mellitus or metabolic syndrome, also contribute. The identification of the underlying cause must be part of the diagnosis as it conditions the prognosis and treatment.

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.

Insuficiència cardíaca crònica; Adults; Sacubitril; Valsartan Chronic heart failure; Adults; Sacubitril; Valsartan Insuficiencia cardíaca crónica; Adultos; Sacubitril; Valsartan SAC/VAL es considera una opció de tractament per a pacients amb insuficiència cardíaca amb fracció d’ejecció reduïda (≤ 35%), nivells elevats de pèptid natriurètic tipus B (PNB) o de fragment aminoterminal del propèptid natriutètic tipus B (NT-proPNB) i que persisteixen simptomàtics (classe NYHA II-III) tot i el tractament estable amb les dosis màximes tolerades d’un IECA o un ARA-II juntament, excepte contraindicació, amb un betablocador i un antagonista de l’aldosterona SAC / VAL se considera una opción de tratamiento para pacientes con insuficiencia cardíaca con fracción de eyección reducida (≤ 35%), niveles elevados de péptido natriurético tipo B (PNB) o de fragmento aminoterminal del propèptid natriutètic tipo B (NT-proPNB ) y que persisten sintomáticos (clase NYHA II-III) a pesar del tratamiento estable con las dosis máximas toleradas de un IECA o un ARA-II junto, excepto contraindicación, con un betabloqueante y un antagonista de la aldosterona SAC / VAL is considered a treatment option for patients with heart failure with reduced ejection fraction (≤ 35%), high levels of type B natriuretic peptide (PNB) or aminothermal fragment of type B natriutetic peptide (NT-proPNB). ) and that they continue to be symptomatic (NYHA class II-III) despite stable treatment with the maximum tolerated doses of an IECA or an ARA-II together, except with contraindication, with a beta-blocker and an aldosterone antagonist

Allogeneic cell therapy; Haplotype frequency; Heart failure Teràpia cel·lular al·logènica; Freqüència haplotípica; Insuficiència cardíaca Terapia celular alogénica; Frecuencia haplotípica; Insuficiencia cardíaca AIMS: Cell therapy can be used to repair functionally impaired organs and tissues in humans. Although autologous cells have an immunological advantage, it is difficult to obtain high cell numbers for therapy. Well-characterized banks of cells with human leukocyte antigens (HLA) that are representative of a given population are thus needed. The present study investigates the HLA allele and haplotype frequencies in a cohort of heart failure (HF) patients. METHODS AND RESULTS: We carried out the HLA typing and the allele and haplotype frequency analysis in 247 ambulatory HF patients. We determined HLA class I (A, B, and C) and class II (DRB1 and DQB1) using next-generation sequencing technology. The allele frequencies were obtained using Python for Population Genomics (PyPop) software, and HLA haplotypes were estimated using HaploStats. A total of 30 HLA-A, 56 HLA-B, 23 HLA-C, 36 HLA-DRB1, and 15 HLA-DQB1 distinct alleles were identified within the studied cohort. The genotype frequencies of all five HLA loci were in Hardy-Weinberg equilibrium. We detected differences in HLA allele frequencies among patients when the etiological cause of HF was considered. There were a total of 494 five-loci haplotypes, five of which were present six or more times. Moreover, the most common estimated HLA haplotype was HLA-A*01:01, HLA-B*08:01, HLA-C*07:01, HLA-DRB1*03:01, and HLA-DQB1*02:01 (6.07% haplotype frequency per patient). Remarkably, the 11 most frequent haplotypes would cover 31.17% of the patients of the cohort in need of allogeneic cell therapy. CONCLUSIONS: Our findings could be useful for improving allogeneic cell administration outcomes without concomitant immunosuppression.

Insuficiència cardíaca crònica; Pautes del tractament farmacològic; IC Chronic heart failure; Patterns of drug treatment; CHF Insuficiencia cardiaca crónica; Pautas del tratamiento farmacológico L’objectiu d’aquest document és harmonitzar les pautes del tractament farmacològic de la insuficiència cardíaca (IC), en el marc del Programa d’harmonització farmacoterapèutica de medicaments en l’àmbit de l’atenció primària i comunitària (PHF APC) del CatSalut.

Insuficiència cardíaca; Medicaments; Recomanacions Heart failure; Medications; Recommendations Insuficiencia cardíaca; Medicamentos; Recomendaciones Document on es donen una sèrie de recomanacions relacionades amb la medicació per tractar la insuficiència cardíaca, així com les complicacions que poden sorgir.

Atenció al pacient crònic; Insuficiència cardíaca; Malaltia pulmonar obstructiva crònica Atención al paciente crónico; Insuficiencia cardíaca; Enfermedad pulmonar obstructiva crónica Chronic patient care; Heart failure; Chronic obstructive pulmonary disease Aquest document pretén establir un marc d’actuació per a la transformació a mitjà termini de l’atenció que es presta als i les pacients crònics des de l’Institut Català de la Salut (ICS), però tenint en compte que molts dels canvis necessaris només són possibles si s’estableixen els mecanismes de col·laboració adequats entre tots els actors del sistema, específicament, si s’estableixen els incentius per tal de garantir-ne la continuïtat, i si evolucionem cap a un model d’atenció que curi i tingui cura dels i les pacients, i alhora serveixi també per reduir les hospitalitzacions innecessàries. L’abordatge s’ha fet escollint la insuficiència cardíaca (IC) i la malaltia pulmonar obstructiva crònica (MPOC), perquè són dues de les malalties que tenen un major impacte en dependència, discapacitat, qualitat de vida i anys de vida perduts al nostre país, i també, perquè concentren una part molt important del cost de la cronicitat.

Insuficiència cardíaca; Tractament; Recomanacions Insuficiencia cardíaca; Tratamiento; Recomendaciones Heart failure; Treatment; Recommendations Aquest document aporta una revisió acurada del coneixement científic actualment disponible sobre la insuficiència cardíaca, i el tradueix en recomanacions per a la pràctica diària. Pel seu contingut docent, la Guia constitueix també un valuós document per facilitar l’adquisició de competències clíniques que ha de caracteritzar el desenvolupament dels professionals de l’Institut Català de la Salut.

Insuficiència cardíaca; Reaccions adverses a medicaments; Interaccions Insuficiencia Cardíaca; Reacciones adversas a medicamentos; Interacciones Heart Failure; Adverse reactions to drugs; Interactions La insuficiència cardíaca (IC) suposa el fracàs de la funció de bomba del cor i la repercussió deletèria en d’altres òrgans. La prevalença de la IC és important en el nostre entorn sanitari i comporta una gran nombre d’ingressos, reingressos i despesa sanitària. Aquests aspectes s’agreugen amb l’augment de la supervivència i de l’edat de la població, i també amb la seva vinculació a la morbimortalitat que comporta. Es tabulen de forma resumida aquells medicaments que poden desencadenar o exacerbar la IC i es documenta la seva associació, ja sigui per toxicitat o disfunció miocardíaca, la magnitud de la seva acció, els possibles mecanismes implicats i la velocitat d’aparició de la IC. També es categoritzen en funció del risc els fàrmacs que poden prolongar l’interval QT i induir torsade de pointes en aquests pacients, de fet més predisposats. Es relacionen els fàrmacs que poden pressuposar un risc afegit de sobrecàrrega de sodi, i es donen els continguts d’aquest ió per presentació. Es delimiten alguns productes complementaris/alternatius que interaccionen amb els fàrmacs que s’utilitzen en el tractament de la patologia cardiovascular. Per acabar, es llisten algunes recomanacions generals per minimitzar la polimedicació i millorar la seguretat en l’àmbit terapèutic d’aquests pacients. La insuficiencia cardíaca (IC) supone el fracaso de la función de bomba del corazón y la repercusión deletérea en otros órganos. La prevalencia de la IC es importante en nuestro entorno sanitario y conlleva una gran número de ingresos, reingresos y gasto sanitario. Estos aspectos se agravan con el aumento de la supervivencia y de la edad de la población, y también con su vinculación a la morbimortalidad que conlleva. Se tabulan de forma resumida aquellos medicamentos que pueden desencadenar o exacerbar la IC y se documenta su asociación, ya sea por toxicidad o disfunción miocárdica, la magnitud de su acción, los posibles mecanismos implicados y la velocidad de aparición de la IC. También se categorizan en función del riesgo los fármacos que pueden prolongar el intervalo QT y inducir torsade de pointes en estos pacientes, de hecho más predispuestos. Se relacionan los fármacos que pueden presuponer un riesgo añadido de sobrecarga de sodio, y se dan los contenidos de este ión por presentación. Se delimitan algunos productos complementarios/alternativos que interaccionan con los fármacos que se utilizan en el tratamiento de la patología cardiovascular. Para acabar, se listan algunas recomendaciones generales para minimizar la polimedicación y mejorar la seguridad en el ámbito terapéutico de estos pacientes. Heart failure (HF) involves the failure of the heart's pump function and the deleterious repercussion on other organs. The prevalence of HF is important in our healthcare environment and entails a large number of admissions, re-admissions and health expenditure. These aspects are aggravated with the increase in survival and the age of the population, and also with its link to the morbidity and mortality it entails. The drugs that can trigger or exacerbate the CI are summarized in a summary form and their association is documented, whether due to myocardial toxicity or dysfunction, the magnitude of their action, the possible mechanisms involved and the speed of the onset of HF. Drugs that can prolong the QT interval and induce torsade de pointes in these patients, in fact more predisposed, are also categorized according to risk. The drugs that may presuppose an added risk of sodium overload are listed, and the contents of this ion are given by presentation. Some complementary / alternative products that interact with drugs that are used in the treatment of cardiovascular pathology are defined. To finish, some general recommendations are listed to minimize the polypharmacy and improve the safety in the therapeutic field of these patients.

Fibrilación Atrial; Insuficiencia Cardíaca; Estudio longitudinal Fibril·lació atrial; Insuficiència cardíaca; Estudi longitudinal Atrial Fibrillation; Heart Failure; Longitudinal study BACKGROUND Heart failure (HF) is frequent and its prevalence is increasing. We aimed to evaluate the epidemiologic features of HF patients, the 1-year follow-up outcomes and the independent predictors of those outcomes at a population level. METHODS AND RESULTS Population-based longitudinal study including all prevalent HF cases in Catalonia (Spain) on December 31st, 2012. Patients were divided in 3 groups: patients without a previous HF hospitalization, patients with a remote (>1 year) HF hospitalization and patients with a recent (

Insuficiència cardíaca; Medicaments; Recomanacions Heart failure; Medications; Recommendations Insuficiencia cardíaca; Medicamentos; Recomendaciones Document on es donen una sèrie de recomanacions relacionades amb la medicació per tractar la insuficiència cardíaca, així com les complicacions que poden sorgir.

Insuficiència cardíaca; Medicaments; Recomanacions Heart failure; Medications; Recommendations Insuficiencia cardíaca; Medicamentos; Recomendaciones Document on es donen una sèrie de recomanacions relacionades amb la medicació per tractar la insuficiència cardíaca, així com les complicacions que poden sorgir.