ABSTRACT
Background: Pharmacological treatment improves survival in patients with heart failure with reduced ejection fraction. The use of sacubutril/valsartan and ivabradine has been recently approved and incorporated in the latest guidelines. Aim: To identify candidates eligible for these therapies among patients treated in a heart failure clinic, considering the inclusion criteria for the PARADIGM-HF and SHIFT trials. Material and Methods: Cross-sectional study on 158 patients aged 62 ± 11 years (67% male) with heart failure and reduced ejection fraction, with at least three months of follow-up and without decompensation. The percentage of patients complying for the inclusion criteria for the PARADIGM-HF y SHIFT trials was determined. Results: In 37%, the etiology of heart failure was ischemic, 49% were in functional class I, their ejection fraction was 33 ± 11% and their median Pro-brain natriuretic peptide was 800 pg/mL. Ninety five percent were treated with vasodilators, 97% with beta-blockers and 82% with aldosterone antagonists. Using PARADIGM-HF and SHIFT criteria, 11 patients (7%) were eligible for sacubitril / valsartan and 21 patients (13.3%) for ivabradine. Among the main causes of non-eligibility for sacubitril / valsartan were being functional class I (48.7%) and not achieving a stable dose of enalapril ≥ 20 mg / day or losartan ≥ 100 mg / day (24.7%). In the case of ivabradine, apart from those in functional class I, the absence of sinus rhythm and a heart rate < 70 / min when receiving a maximal tolerated dose of beta-blockers, were present in 22%. Conclusions: A low percentage of our patients were eligible for these therapies. Among the causes that explain these results were clinical stability, a high percentage of patients in functional class I and being in a disease modifying treatment.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Tetrazoles/administration & dosage , Cardiovascular Agents/administration & dosage , Angiotensin Receptor Antagonists/administration & dosage , Ivabradine/administration & dosage , Aminobutyrates/administration & dosage , Heart Failure/drug therapy , Cross-Sectional Studies , Patient Selection , Dose-Response Relationship, Drug , Drug Combinations , Heart Failure/physiopathologyABSTRACT
La calcifilaxis es un trastorno severo, poco frecuente que afecta a los pacientes con insuficiencia renal crónica terminal en diálisis periódica. Es una vasculopatía que se caracteriza por la calcificación dela capa media de las arterias sistémicas, con la consecuente isquemia distal de los tejidos, principalmente piel y tejido subcutáneo, llevando finalmente a la formación de úlceras, necrosis y dolor crónico. El diagnóstico se confirma con histología.Entre los principales factores de riesgo destacan el hiperparatiroidismo secundario, un producto calcio / fósforo elevado (superior a 70), o ambas cosas, entre otros. La Calcifilaxis tiene mal pronóstico, con alta mortalidad en la mayoría de los casos antes de los 10 meses de diagnosticada, siempre por causa séptica.Se presenta el caso de un paciente con Insuficiencia Renal Crónica secundaria a nefropatía hipertensiva, en hemodiálisis, que desarrolló calcifilaxis, y secundario a ésta, dolor intratable. Se utilizaron diversos fármacos para el manejo del dolor, entre ellos antiinflamatorios no esteroidales, derivados de la morfina, antidepresivos tricíclicos y gabapentina. La eficacia del tratamiento fue evaluada mediante Escala Visual Análoga. Los objetivos del trabajo son replantear los valores aceptados de producto calcio / fósforo y la utilidad de gabapentina en el manejo del dolor. Se concluye que las acciones dirigidas contra la calcifilaxis deben estar orientadas principalmente hacia su prevención, manteniendo un producto calcio / fósforo en cifras inferiores a 55. Además la gabapentina parece ser el fármaco con mejores resultados en el manejo del dolor en pacientes con calcifilaxis.