Intervención de la telemedicina en pacientes peruanos con insuficiencia cardíaca en tiempos de COVID-19 / Telemedicine Intervention in Peruvian Patients with Heart Failure in Times of COVID-19

Introducción: La insuficiencia cardíaca tiene un gran impacto epidemiológico, no solo por su alta morbilidad y mortalidad, sino también por el alto costo en servicios hospitalarios. Las tasas de hospitalización por reagudizaciones y readmisiones luego del alta se han incrementado los últimos años, lo que constituye en la actualidad un problema de salud pública. Objetivo: Evaluar el efecto de la intervención de la telemedicina en pacientes peruanos con insuficiencia cardíaca en tiempos de COVID-19. Métodos: Se utilizó un diseño cuasi experimental con evaluación antes y después de la intervención en 32 pacientes provenientes de Chimbote (Perú), entre los meses de enero a junio del 2021, que aceptaron participar en el estudio y cumplieron con los criterios de inclusión y exclusión. Se utilizó una ficha de recolección de datos que registró las características clínicas de los pacientes, frecuencia de hospitalización y clase funcional, así como el cuestionario de Kansas City que midió la calidad de vida relacionada a salud. En la intervención, se implementaron actividades de telemedicina que comprendió teleconsulta médica de cardiología, telemonitoreo y teleorientación de enfermería, y teleorientación de nutrición. Resultados: Se redujo la frecuencia de hospitalización de 9,4 por ciento a 0 por ciento en los pacientes categorizados en clase funcional III disminuyó de 28,1 por ciento a 15,6 por ciento, y el score general se mejoró de 65,8 a 69,6 puntos. Conclusiones: La intervención de la telemedicina mejoró los resultados sanitarios de los pacientes peruanos con insuficiencia cardíaca(AU)

Introduction: Heart failure has a great epidemiological impact, not only because of its high morbidity and mortality, but also because of the high cost in hospital services. Hospitalization rates for exacerbations and readmissions after discharge have increased in recent years, which is currently a public health problem. Objective: To evaluate the effect of telemedicine intervention in Peruvian patients with heart failure in COVID-19 times. Methods: A quasi-experimental design was used with evaluation before and after the intervention in 32 patients from Chimbote (Peru), between January and June 2021, who agreed to participate in the study and met the inclusion and exclusion criteria. A data collection form was used to record the clinical characteristics of the patients, frequency of hospitalization and functional class, as well as the Kansas City questionnaire that measured health-related quality of life. Telemedicine activities were implemented in the intervention, including cardiology medical teleconsultation, telemonitoring and nursing tele-guidance, and nutrition tele-guidance. Results: The frequency of hospitalization was reduced from 9.4 to 0 percent, while in patients categorized in functional class III it decreased from 28.1 to 15.6 percent. The overall score was improved from 65.8 to 69.6 points. Conclusions: The telemedicine intervention improved health outcomes in Peruvian patients with heart failure(AU)

Impact of different types of heart failure on long-term renal prognosis in patients with renal insufficiency and heart failure / 中华肝脏病杂志

Objective: To investigate the effects of different types of heart failure on long-term renal prognosis in patients with renal insufficiency and heart failure. Methods: The patients with renal insufficiency [baseline estimated glomerular filtration rate < 60 ml·min-1·(1.73 m2)-1] and heart failure followed-up for more than 2 years and hospitalized in Beijing Anzhen Hospital, Capital Medical University from January 1, 2018 to June 30, 2019 were enrolled in this retrospective cohort study. The patients were divided into three groups based on the baseline left ventricular ejection fraction (LVEF): heart failure with reduced ejection fraction (HFrEF, LVEF < 40%) group, heart failure with mildly reduced ejection fraction (HFmrEF, 40% ≤ LVEF < 50%) group, and heart failure with preserved ejection fraction (HFpEF, LVEF ≥ 50%) group. Clinical data were collected and endpoint events (adverse renal outcome: the composite outcome of all-cause death or worsening renal function) were recorded through the electronic medical record system. Kaplan-Meier survival curve was used to analyze the incidence of endpoint events of different heart failure subgroups. Cox regression model was performed to analyze the risk factors of endpoint events. Results: A total of 228 patients with renal insufficiency complicated with heart failure were included, with age of (68.14±14.21) years old and 138 males (60.5%). There were 85 patients (37.3%) in the HFrEF group, 40 patients (17.5%) in the HFmrEF group, and 103 patients (45.2%) in the HFpEF group. There were statistically significant differences in age, proportion of age > 65 years old, sex distribution, systolic blood pressure, pulmonary artery pressure, serum sodium, serum calcium, hemoglobin, serum cholesterol, low-density lipoprotein cholesterol, serum uric acid, troponin I, hypersensitive C-reactive protein, LVEF, ventricular septal thickness, left ventricular end-diastolic diameter, B-type natriuretic peptide, estimated glomerular filtration rate, and proportions of using beta blockers, using spirolactone, myocardial infarction, hypertension, cardiomyopathy and atrial fibrillation (all P < 0.05). During the median follow-up of 36.0 (28.0, 46.0) months, 73 patients (32.0%) had adverse renal outcomes. The total incidences of adverse renal outcomes were 32.9% (28/85) in the HFrEF group, 35.0% (14/40) in the HFmrEF group, and 30.1% (31/103) in the HFpEF group. Kaplan-Meier survival curve showed that there was no significant difference in the incidence of endpoint events among the three groups (log-rank test χ2=0.17, P=0.680). Multivariate Cox regression analysis showed that HFpEF (HFrEF as reference, HR=2.430, 95% CI 1.055-5.596, P=0.037) was an independent influencing factor of endpoint events. Conclusions: The long-term renal prognosis of patients with renal insufficiency and heart failure is poor. Compared with HFrEF, HFpEF is an independent risk factor of poor long-term renal prognosis in renal insufficiency patients with heart failure.

Comportamiento de características seleccionadas en pacientes hospitalizados por neumonía adquirida en la comunidad y algunas asociaciones de interés práctico / Behavior of selected characteristics in patients hospitalized for community-acquired pneumonia and some associations of practical interest

La neumonía adquirida en la comunidad constituye una de las afecciones respiratorias que provoca más demanda de asistencia médica, y es responsable del mayor número de fallecidos por enfermedades infecciosas en Cuba. El objetivo del estudio ha sido determinar el comportamiento de características seleccionadas en pacientes hospitalizados por neumonía y precisar la existencia de asociaciones entre algunas de estas características.Se realizó un estudio observacional, con diseño descriptivo, que incluyó 1,809 pacientes hospitalizados por neumonía entre enero de 2012 y febrero de 2020. Fueron analizadas características relacionadas con las condiciones de base, clínico-radiológicas, y relativas al manejo y la evolución, mediante análisis bivariante y multivariante (regresión logística). La serie estuvo constituida fundamentalmente por pacientes ancianos (79%), mientras que el 20% presentaba la condición de encamamiento. Esta condición se asoció significativamente con el estado de demencia avanzada (OR 7,6[5,5;10,4]), y fue determinante en la presentación "solapada" del proceso (OR 1,5[1,09;2]). La presentación "solapada" de la neumonía estuvo significativamente asociada al ingreso tardío (OR 1,6[1,2;2,2]). Como conclusiones se ratifica el lugar que ocupan varios elementos en las características de la morbilidad por neumonía: edad avanzada, presencia de comorbilidades, y presentación no clásica del proceso. Fueron constatadas interrelaciones de importancia práctica entre la presencia de comorbilidades particulares, las formas clínicas de presentación, el momento del ingreso, y la utilización de antimicrobianos durante la atención prehospitalaria del paciente. Se destaca el papel del encamamiento en la extensión radiológica del proceso neumónico y en la presencia de derrame pleural de mediana o gran cuantía al momento del ingreso.

Community-acquired pneumonia is one of the respiratory conditions that causes the greatest demand for medical care, and is responsible for the largest number of deaths from infectious diseases in Cuba. The objective of the study was to determine the behavior of selected characteristics in patients hospitalized for pneumonia and to specify the existence of associations between some of these characteristics. An observational study, with a descriptive design, was carried out, which included 1,809 patients hospitalized for pneumonia between January 2012 and February 2020. Characteristics related to the basic, clinical-radiological conditions, and relative to management and evolution were analyzed, through analysis bivariate and multivariate (logistic regression). The series consisted mainly of elderly patients (79%), while 20% were bedridden. This condition was significantly associated with the state of advanced dementia (OR 7.6[5.5;10.4]) and was decisive in the "overlapping" presentation of the process (OR 1.5[1.09;2]). The "overlapping" presentation of pneumonia was significantly associated with late admission (OR 1.6[1.2;2.2]). As conclusions, the place occupied by several elements in the characteristics of pneumonia morbidity is ratified: advanced age, presence of comorbidities, and non-classical presentation of the process. Interrelationships of practical importance were found between the presence of comorbidities, the clinical forms of presentation, the time of admission, and the use of antimicrobials during the patient's prehospital care. The role of bed rest in the radiological extension of the pneumonic process and in the presence of medium or large pleural effusion at the time of admission is highlighted.

Complicaciones cardiovasculares en pacientes COVID-19 hospitalizados en Unidades de Pacientes Críticos en Chile. Registro COVICAR / Cardiovascular complications in COVID-19 patients admitted to intensive care units in Chilean hospitals

BACKGROUND: Patients with a cardiovascular (CV) history may be at greater risk of becoming ill and die due to SARS-CoV-2. AIM: To assess the incidence of CV complications in COVID-19 patients, the type of complication, and their association with CV history. MATERIAL AND METHODS: The clinical course of 1,314 patients with COVID-19 admitted consecutively to critical care units of 10 Chilean hospitals was registered between April and August of 2020. RESULTS: The median age of patients was 59 years and 66% were men. One hundred-four (8%) had a CV history, namely heart failure (HF) in 53 (4.1%), coronary heart disease in 50 (3.8 %), and atrial fibrillation in 36 (2.7 %). There were CV complications in 359 patients (27.3%). The most common were venous thrombosis in 10.7% and arrhythmias in 10.5%, HF in 7.2%, type 2 acute myocardial infarction in 4.2%, arterial thrombosis in 2.0% and acute coronary syndrome (ACS) in 1.6%. When adjusted by age, sex and risk factors, only HF (Odds ratio (OR) = 7.16; 95% confidence intervals (CI), 3.96-12.92) and ACS (OR = 5.44; 95% CI, 1.50-19.82) were significantly associated with CV history. There was no association with arrhythmias, type 2 acute myocardial infarction, arterial or venous thrombosis. CONCLUSIONS: Patients with a history of CV disease are at greater risk of suffering HF and ACS when hospitalized due to COVID-19. Arrhythmias, type 2 AMI, and arterial or venous thrombosis occur with the same frequency in patients with or without CV history, suggesting that these complications depend on inflammatory phenomena related to the infection.

Association between short-term exposure to ambient nitrogen dioxide and the risk of heart failure hospitalization / 中华预防医学杂志

Objective: To assess the association between short-term exposure level of nitrogen dioxide and the hospitalization risk of heart failure. Methods: Based on China-PEACE Retrospective Heart Failure Study, 117 364 hospitalized patients with heart failure were recruited from 92 hospitals in 62 cities throughout China between January 1, 2015 and December 31, 2015. The daily exposure level of nitrogen dioxide, temperature, and humidity in the same cities during the same period were also collected. We applied the generalized additive model and Bayesian hierarchical model to quantify the lagged effect and cumulative effect of short-term (0-3 days) exposure to ambient nitrogen dioxide on the hospitalization risk of heart failure. We further conducted stratified analyses by age, region, and season to identify any difference in the associations between short-term nitrogen dioxide exposure and heart failure among subgroups. Results: The mean age for participants in the analysis was (70.32±12.22) years. The median, minimum and maximum of daily nitrogen dioxide concentration in 62 cities from January 1, 2015 to December 31, 2015 was 26.4 μg/m3, 2.33 μg/m3 and 150.25 μg/m3, respectively. The exposure level of nitrogen dioxide at the same day was associated with the hospitalization risk of heart failure (OR=1.022, 95%CI: 1.012, 1.031). Significant effects were also observed in the moving average concentrations from lag 0-1 to lag 0-3 day (OR=1.020, 95%CI: 1.009, 1.030; OR=1.016, 95%CI: 1.004, 1.028; OR=1.013, 95%CI: 1.001, 1.026). Moreover, all of the associations between short-term exposure to nitrogen dioxide and the risk of heart failure hospitalization were statistically significant, with no significant difference in all subgroups stratified by age, region, and season. Conclusion: A higher level of short-term exposure to nitrogen dioxide could trigger more hospitalizations with heart failure.

Avaliação de pacientes com insuficiência cardíaca admitidos em hospital secundário / Evaluation of patients with heart failure admitted to a secondary hospital

Objetivo: Elaborar um perfil clínico e epidemiológico de pacientes com insuficiência cardíaca descompensada, de acordo com a etiologia da descompensação, e analisar o desfecho clínico dentre os diferentes grupos etiológicos encontrados. Métodos: Estudo retrospectivo e observacional. Os pacientes foram reunidos em seis grupos, conforme etiologia de descompensação, e comparados de acordo com dados coletados. Realizaram-se verificação por meio da análise de variância e teste exato de Fisher. Obteve-se significância estatística por meio do valor de p <0,10. Resultados: Foram analisados 123 prontuários de pacientes admitidos entre 2016 e 2018. A maior causa de descompensação da doença foi a má aderência ao tratamento (32,5%). Além disso, a doença foi responsável por maior tempo de internação (13,5 dias) e número de óbitos (seis). Conclusão: Otimizando-se os cuidados e o acompanhamento desses pacientes, pode haver um importante impacto sobre a incidência, as complicações e a frequência de descompensações. (AU)

Objective: To develop a clinical and epidemiological profile of patients with decompensated heart failure according to the etiology of decompensation and to analyze the clinical outcome among the different etiological groups found. Methods: This is a retrospective, observational study. Patients were divided in six groups according to etiology of decompensation and were compared according to data collected. Variance analysis and Fisher's exact test were performed. Statistical significance was obtained by means of p-value <0.10. Results: We analyzed 123 medical records of patients admitted between 2016 and 2018. The greatest cause of decompensation was the poor adherence to treatment (32.5%). In addition, the disease was responsible for longer hospitalization time (13.5 days) and number of deaths (six). Conclusion: Optimizing care and follow-up of these patients can have an important impact on the incidence, complications, and frequency of decompensation. (AU)

Relationship between the ideal cardiovascular health behaviors and factors and newonset heart failure / 中华心血管病杂志

Objective: To explore the relationship between the ideal cardiovascular health behaviors and factors and newonset heart failure. Methods: It was a prospective cohort study. People who attended the 2006-2007 physical examination of Kailuan Group Company and with complete data of cardiovascular behaviors and related factors were eligible for this study. A total of 95 167 participants who were free of valvular heart diseases, congenital heart diseases and a prior history of heart failure were included. Basic cardiovascular health score (CHS) of each participant was calculated. Participants were divided into 3 groups according to CHS. Group 1:CHS<8 (n=26 640), Group 2:8≤CHS<10 (n=35 230), Group3:CHS≥10 (n=33 297). The general clinical data and laboratory test results were collected. The outcome was defined as the first occurrence of heart failure at the end of followup(December 31, 2016). Cox regression model was used to determine the association between baseline CHS and the risk of newonset heart failure. Results: After a median followup of 10.3 years, the incidence of newonset heart failure in the group of CHS<8,8≤CHS<10,CHS≥10 were 2.7%(729/26 640), 1.8%(651/35 230) and 1.1%(360/33 297),respectively. After adjustment for age, sex, history of myocardial infarction, history of atrial fibrillation, income, alcohol consumption, education and the use of antihypertensive, cholesterol-lowering, glucose-lowering medications, compared with the group of CHS<8, the Cox regression model showed that HRs of the group of 8≤CHS<10 and CHS≥10 were 0.68 (95%CI 0.61-0.75), 0.49 (95%CI 0.43-0.55), respectively. Cox regression analysis after removing each single cardiovascular behavior or factor showed that the HR value range ability was as follows:systolic blood pressure(HR=0.78,95%CI 0.74-0.82), body mass index(HR=0.78,95%CI 0.74-0.82), fasting blood glucose (HR=0.77,95%CI 0.73-0.81), total cholesterol(HR=0.76,95%CI 0.72-0.80), physical exercise(HR=0.72,95%CI 0.69-0.76), smoking(HR=0.75,95%CI 0.71-0.79) and salt intake(HR=0.73,95%CI 0.69-0.77). Conclusion: CHS is negatively associated with the risk of newonset heart failure, and there is a dose-response relationship between the two indexes.

Factors Predicting Heart Failure in Children Admitted to a Pediatric Emergency Ward in a Developing Country

Abstract Background Heart failure is an important cause of morbidity and mortality in children. Objective To determine the clinical characteristics of children with acute heart failure syndrome in the emergency ward of River state university teaching hospital, Nigeria and identify factors associated with poor outcomes. Methods This was an 18month retrospective review of the acute heart failure register. Poor outcome measures were defined as the persistence of heart failure after 4 days on admission or death. Results Ninety-two (4.1%) of 2,244 children admitted were in heart failure, Non-cardiac disorders [bronchopneumonia 32(36%), sepsis 21(24%), severe malaria 10(11%), sickle cell anaemia 8(9%) and tuberculosis 3(3%)] contributed to 74(83%) while congenital heart disease(CHD) was 15(17%). Seventy-four (83%) were discharged, 10(11%) died and 4(5%) left against medical advice. The median time to resolution of heart failure was significantly 24 hours longer for malnourished children than those with normal-nutritional status, 72Vs48hrs, log rank:0.001. Those with modified Ross score of >7 and sepsis were more likely to die, OR,8.8(95% CI,1.2 to 72.5,p = 0.02) and 3.9(95% CI,1.01 to 15.2;p =0.04). Age <2yrs(OR,3.1,CI,1.2 to 8.5,p = 0.02), and CHD (OR 3.6,95% CI,1.1 to 12,P=0.02) were associated with a higher likelihood of having a poor outcome. Each unit increase in weight for age Z score of 1, decreased the odds of having a poor outcome, OR,0.77 (95% CI,0.63 to 0.95)p=0.016. Conclusion Heart failure in our setting is predominantly caused by non-cardiac disorders. Modified Ross score of >7 and sepsis are risk factors for mortality in children with heart failure. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Perfil epidemiológico da morbimortalidade por insuficiência cardíaca no Brasil entre 2013 a 2017 / Epidemiological profile of morbidity and mortality due to heart failure in Brazil between 2013 and 2017

Resumo Este estudo teve como objetivo descrever o perfil epidemiológico da morbimortalidade por insuficiência cardíaca no Brasil no período de 2013 a 2017. Estudo ecológico e descritivo realizado a partir de dados do Departamento de Informática do Sistema Único de Saúde. Os dados coletados foram referentes ao sexo, faixa etária, raça/cor, internações e óbitos. Para análise dos dados, adotou-se estatística descritiva simples (frequências absolutas e relativas). Durante o quinquênio foram registrados 865.327 internações e 90.990 óbitos, correspondendo a uma taxa de mortalidade de 10,52%. A região sudeste evidenciou maior porcentagem de internações (41,66%), óbitos (46,83%) e taxa de mortalidade (11,82%). A população com idade ≥ 80 anos apresentou maior número de internações (21,95%), óbitos (33,54%) e taxa de mortalidade (16,07%). O sexo masculino alcançou maior número de internações (51,29%) e o feminino obteve maior número de óbitos (50,53%) e taxa de mortalidade (10,91%). A cor branca se destacou com 37,08% das internações e 36,62% dos óbitos e a maior taxa de mortalidade foi observada na população indígena (11,04%). Este estudo traz evidência sobre as disparidades nos internamentos, óbitos e taxa de mortalidade por Insuficiência Cardíaca de acordo com a idade, sexo e cor/raça distribuídas nas regiões brasileiras, o que reflete a dificuldade que certas populações de grupos étnicos possuem com relação ao acesso aos serviços de saúde e o diagnóstico por meio de tecnologias de alta complexidade. Há, desse modo, a necessidade de implementação de medidas preventivas da patologia, promoção e proteção da saúde especialmente para a população indígena.

Abstract The purpose of this study was to describe the epidemiological profile of morbidity and mortality by heart failure in Brazil in the period from 2013 to 2017. Ecological and descriptive study conducted with data about heart failure from the Information Technology Department of the Unified Health System. The data were sex, age groups, race, hospitalization and deaths. For analysis of the data, it was adopted the simple descriptive statistical analysis (absolute and relative frequencies). During the quinquennium, it were registered 865.327 hospitalizations and 90.990 deaths, corresponding to a mortality rate of 10,52%. The southeast region has highlighted higher percentage of hospitalizations (41,66%), deaths (46,83%), and mortality rate (11,82%). The population aged ≥ 80 years old has been higher number of hospitalizations (21,95%), death (33,54%) and mortality rate (16,07%). The masculine sex obtained the higher number of hospitalizations (51,29%). However, the female sex exceeded the number of deaths in the male population (50,53%) and mortality rate (10,91%). The white color/race highlighted 37,08% of the hospitalizations and 36,62% of the deaths. In relation to the mortality rate, the indigenous population has been higher rate (11,04%). This study provides evidence about disparities in hospitalizations, deaths and mortality rates due to heart failure according to age, sex and color / race distributed in Brazilian regions, which reflects the difficulty that certain populations of ethnic groups have with regard to access health services and diagnosis through highly complex technologies. Thus, there is a need to implement preventive measures against pathology, promoting and protecting health especially for the indigenous population.

Resumen Este estudio tuvo como objetivo describir el perfil epidemiológico de la morbimortalidad por insuficiencia cardíaca en Brasil, entre el período de 2013 y 2017. Ecológico y descriptivo realizado con datos secundarios del Departamento de Informática del Sistema Único de Salud. Los datos fueron sexo, grupo de edad, raza, hospitalizaciones y muertes. Para el análisis de los datos se ha adoptado estadística descriptiva simple (frecuencias absolutas y relativas). Durante el quinquenio fueran registradas 865.327 hospitalizaciones y 90.990 muertes, que corresponde a tasa de mortalidad de 10,52%. La región sudeste ha evidenciado mayor porcentaje de hospitalizaciones (41,66%), muertes (46,83%) y tasa de mortalidad (11,82%). El grupo etario igual o superior a 80 años tuvo mayor número de hospitalizaciones (21,95%), muertes (33,54%) y tasa de mortalidad (16,07%). El sexo masculino obtuvo mayor número de hospitalizaciones (51,29%) y el femenino, mayor número de muertes (50,53%) y tasa de mortalidad (10,91%). El color/ raza blanca se ha destacado con 37,08% de las hospitalizaciones y 36,62% de las muertes, y la mayor tasa de mortalidad ha sido observada en la población indígena (11,04%). Este estudio proporciona evidencia sobre las disparidades en las hospitalizaciones, las muertes y las tasas de mortalidad debido a insuficiencia cardíaca según edad, sexo y color / raza distribuidos en las regiones brasileñas, lo que refleja la dificultad que ciertas poblaciones de grupos étnicos tienen con respecto al acceso a los Servicios de salud y diagnóstico a través de tecnologías altamente complejas. Por lo tanto, existe la necesidad de implementar medidas preventivas contra la patología, promoviendo y protegiendo la salud especialmente para la población indígena.

Decompensated Heart Failure with Mid-Range Ejection Fraction: Epidemiology and In-Hospital Mortality Risk Factors

Abstract Background: Recently, a new HF entity, with LVEF between 40-49%, was presented to comprehend and seek better therapy for HF with preserved LVEF (HFpEF) and borderline, in the means that HF with reduced LVEF (HFrEF) already has well-defined therapy in the literature. Objective: To compare the clinical-therapeutic profile of patients with HF with mid-range LVEF (HFmrEF) with HFpEF and HFrEF and to verify predictors of hospital mortality. Method: Historical cohort of patients admitted with decompensated HF at a supplementary hospital in Recife/PE between April/2007 - August/2017, stratified by LVEF (< 40%/40 - 49/≥ 50%), based on the guideline of the European Society of Cardiology (ESC) 2016. The groups were compared and Logistic Regression was used to identify predictors of independent risk for in-hospital death. Results: A sample of 493 patients, most with HFrEF (43%), HFpEF (30%) and HFmrEF (26%). Average age of 73 (± 14) years, 59% men. Hospital mortality 14%, readmission within 30 days 19%. In therapeutics, it presented statistical significance among the 3 groups, spironolactone, in HFrEF patients. Hospital death and readmission within 30 days did not make difference. In the HFmrEF group, factors independently associated with death were: valve disease (OR: 4.17, CI: 1.01-9.13), altered urea at admission (OR: 6.18, CI: 1.78-11.45) and beta-blocker hospitalization (OR: 0.29, CI: 0.08-0.97). In HFrEF, predictors were: prior renal disease (OR: 2.84, CI: 1.19-6.79), beta-blocker at admission (OR: 0.29, CI: 0.12-0.72) and ACEI/ ARB (OR: 0.21, CI: 0.09-0.49). In HFpEF, only valve disease (OR: 4.61, CI: 1.33-15.96) and kidney disease (OR: 5.18, CI: 1.68-11.98) were relevant. Conclusion: In general, HFmrEF presented intermediate characteristics between HFrEF and HFpEF. Independent predictors of mortality may support risk stratification and management of this group.

Relationship between functional capacity, performance and symptoms in hospitalized patients with heart failure / Relación entre capacidad funcional, rendimiento y síntomas en pacientes hospitalizados con insuficiencia cardíaca / Relação entre capacidade funcional, desempenho e sintomas em pacientes internados com insuficiência cardíaca

ABSTRACT Objectives: to evaluate the prevalence of symptoms in heart failure patients and to investigate the relationship between symptoms, functional capacity and performance. Methods: cross-sectional study, developed at a hospital specializing in cardiology. The sample (n=170) consisted of patients with heart failure, assessed by means of a sociodemographic form, New York Heart Association Functional Class, Edmonton Symptom Rating Scale and Karnofsky Physical Performance Scale. Analyzes were performed using Spearman's Correlation and Pearson's Chi-Square test. Results: dyspnea, fatigue and edema were the main symptoms that led to the search for health services. During hospitalization, the main symptoms were anxiety, sleep disturbance and sadness. Weak negative correlations were observed between functionality, functional class, and symptom overload. Conclusions: the prevalence of symptoms was high and changed throughout the hospitalization period. Patients with poorer functional capacity and poorer performance had greater symptom overload.

RESUMEN Objetivos: evaluar la prevalencia de síntomas en pacientes con insuficiencia cardíaca e investigar la relación entre los síntomas, la capacidad funcional y el rendimiento. Métodos: estudio transversal, desarrollado en un hospital especializado en cardiología. La muestra (n=170) consistió en pacientes con insuficiencia cardíaca, evaluados mediante una forma sociodemográfica, New York Heart Association Functional Class, Edmonton Symptom Rating Scale y Karnofsky Physical Performance Scale. Los análisis se realizaron utilizando la Correlación de Spearman y la prueba de Chi-cuadrado de Pearson. Resultados: disnea, fatiga y edema fueron los principales síntomas que llevaron a la búsqueda de servicios de salud. Durante la hospitalización, los síntomas principales fueron ansiedad, trastornos del sueño y tristeza. Se observaron correlaciones negativas débiles entre funcionalidad, clase funcional y sobrecarga de síntomas. Conclusiones: la prevalencia de síntomas fue alta y cambió a lo largo del período de hospitalización. Los pacientes con peor capacidad funcional y peor rendimiento tuvieron una mayor sobrecarga de síntomas.

RESUMO Objetivos: avaliar a prevalência de sintomas em pacientes com insuficiência cardíaca e investigar a relação entre sintomas, capacidade funcional e desempenho. Métodos: estudo transversal, desenvolvido em hospital especializado em cardiologia. A amostra (n=170) foi composta por pacientes com insuficiência cardíaca, avaliados por meio de formulário sociodemográfico, Classe Funcional da New York Heart Association, Escala de Avaliação de Sintomas de Edmonton e Escala de Desempenho Físico de Karnofsky. Foram feitas análises através da Correlação Spearman e teste Chi-Quadrado de Pearson. Resultados: dispneia, fadiga e edema foram os principais sintomas que levaram à busca pelo serviço de saúde. Durante a internação, os principais sintomas foram ansiedade, alterações do sono e tristeza. Observaram-se correlações negativas fracas entre funcionalidade, classe funcional e sobrecarga de sintomas. Conclusões: a prevalência de sintomas foi elevada e se modificou ao longo do período de internação. Pacientes com pior capacidade funcional e pior desempenho apresentaram maior sobrecarga de sintomas.

Heart Failure: An Overview of Morbidity and Mortality in Rio Grande do Sul

Abstract Background: Heart failure (HF) is the final pathway of most cardiac diseases. Although the prevalence of HF has increased, due to the ageing of the population, more comprehensive data have shown a reduction in the percentage of HF hospital admissions over the last years. Objective: Assess the morbidity and mortality of HF patients in Brazil, Rio Grande do Sul and Porto Alegre. Method: The study is a retrospective analysis of data from the Brazilian Unified Health System's (Sistema Único de Saúde [SUS]) Department of Informatics (DataSUS). We evaluated the incidence of HF hospital admissions, the average length of stay, hospital costs and sex ratio, during a ten-year period (2007 to 2016). Due to availability of the system, mortality rate and age range, the total duration of the study was nine years. Results: Within this period, the percentage of hospitalizations for HF decreased. On the other hand, the length of stay increased in all regions studied. Mortality rates were in decline in all regions. Hospital costs showed an increase of 110.8%. HF was more prevalent in patients between the seventh and eighth decades of life, with men being more affected than women, except in Rio Grande do Sul. Conclusion: We conclude that, in spite of the high costs of HF to healthcare providers, hospitalizations and mortality rates have shown a significant decline over the last years, which results from the advances in the treatment of this disease, through initiatives to improve patient education, engagement and planning in health care and self-care.

Clinimetric analysis of heart failure in Mexican patients / Análisis clinimétrico de la insuficiencia cardiaca en pacientes mexicanos

Abstract Heart failure (HF) is a syndrome characterized basically by a circulatory deficit to cover the metabolic and energetic demands of the body. This condition has a broad spectrum in its clinical presentation, affects the quality of life significantly, impacts the family/social environment, and generates a great demand for health services. The purpose of this research is to report the situational diagnose of patients with HF in Mexico. We evaluated 292 patients, 70.2% were men. Average age was 56.7 +- 14.3 years. Ischemic heart disease is the main etiology (98 patients, 33.9%) followed by hypertensive (22.6%) and idiopathic (23.3%) heart disease. The associated clinical background was obesity (31.1%), systemic hypertension (36.7%), myocardial infarction (26.4%), and dyslipidemia (15.1%). The most common symptom was stress dyspnea (41.4%) and jugular vein engorgement at physical examination (32.5%). Anemia was observed in 1% of patients. The average left ventricular ejection fraction was 29.2 +- 10.6%. Sinus rhythm was the most frequently detected in 84.9%. 19.9% of patients had an implantable cardioverter-defibrillator or cardiac resynchronization therapy. 13.7% of patients with QRS > 130 ms. In our population, the meta-analysis global group in chronic heart failure risk score calculated was 16.8 +- 5.7 and for EMPHASIS 3.3 +- 1.5. We observed that age at presentation in HF in this analysis is at least 10 years younger than in other reports. The grade of obesity takes relevance in our group. The association of anemia and HF in Mexico is rare.

Resumen La insuficiencia cardiaca es un síndrome caracterizado fundamentalmente por un déficit circulatorio para cubrir las demandas metabólicas y energéticas del organismo. Esta entidad tiene un amplio espectro en su presentación clínica, afecta de manera significativa la calidad de vida, impacta en el entorno familiar/social y genera una gran demanda de los servicios de salud. El propósito de esta investigación es reportar el diagnóstico situacional de pacientes con insuficiencia cardiaca (IC) en México. Evaluamos 292 enfermos, 70.2% eran hombres. Con edad promedio 56.7 +- 14.3 años. La principal etiología es la cardiopatía isquémica (33.9%), seguida de la hipertensiva (22.6%) e idiopática (23.3%). Los antecedentes clínicos asociados fueron: obesidad (31.1%), hipertensión arterial sistémica (36.7%), infarto al miocardio (26.4%) y dislipidemia (15.1%). El síntoma con mayor presentación fue la disnea de esfuerzos (41.4%) y a la exploración física la ingurgitación yugular (32.5%). Se observó anemia en 1% de los enfermos. La fracción de expulsión del ventrículo izquierdo (FEVI) promedio fue de 29.2 + 10.6%. El ritmo sinusal fue el más frecuentemente detectado en 84.9%. El 19.9% de los pacientes tenían instalado un desfibrilador automático implantable (DAI) o tratamiento de resincronización cardiaca (TRC). El 13.7% de los enfermos con QRS mayor de 130 ms. El riesgo (MAGGIC) calculado en nuestro grupo poblacional fue de 16.8 +- 5.7 y para EMPHASIS 3.3 +- 1.5. Observamos que la edad de presentación de la IC en el presente análisis es menor por 10 años en comparación con otros reportes. El grado de obesidad toma relevancia en nuestro grupo. La asociación de anemia e IC en México es poco frecuente.

Insuficiencia cardíaca con fracción de expulsión preservada: el lado oscuro de una vieja enfermedad / Heart failure with preserved ejection fraction: the dark side of an old disease

Resumen La insuficiencia cardíaca (IC) es un problema de salud pública global con más de 37 millones de individuos afectados en el mundo. La insuficiencia cardíaca con fracción de expulsión preservada (ICFEp) representa una categoría cada vez más frecuente en la práctica clínica, constituye hasta el 60% de los casos y presenta diferencias importantes en el diagnóstico y tratamiento en comparación con la insuficiencia cardíaca y la fracción de expulsión reducida. Esta revisión de ICFEp expone la epidemiología, delimita los principales factores de riesgo y mecanismos fisiopatológicos, identifica las características clínicas/paraclínicas y los criterios diagnósticos, y finaliza con un llamado para realizar investigación en este país.

Abstract Heart failure is a global public health problem, with more than 37 million patients living with heart failure around the world. Heart failure with preserved ejection fraction is an increasingly common category (approximately 60% of the cases) and shows remarkable differences in diagnosis and treatment when compared with heart failure with reduced ejection fraction. The current review covers epidemiology, risk factors, pathophysiologic mechanisms, clinical and paraclinical characteristics and diagnostic criteria of heart failure with preserved ejection fraction and concludes with a plea for original research in our country.

Heart Failure with Mid-Range Ejection Fraction - State of the Art / Insuficiência Cardíaca com Fração de Ejeção Intermediária - Estado da Arte

Abstract In 2016, the European Society of Cardiology (ESC) recognized heart failure (HF) with ejection fraction between 40 and 49% as a new HF phenotype, HF with mid-range ejection fraction (HFmrEF), with the main purpose of encouraging studies on this new category. In 2018, the Brazilian Society of Cardiology adhered to this classification and introduced HFmrEF in Brazil. This paper presents a narrative review of what the literature has described about HFmrEF. The prevalence of patients with HFmrEF ranged from 13 to 24% of patients with HF. Analyzing the clinical characteristics, HFmrEF shows intermediate characteristics or is either similar to HF with preserved ejection fraction (HFpEF) or to HF with reduced fraction (HFrEF). Regarding the prognosis, HFmrEF's all-cause mortality is similar to HFpEF's and lower than HFrEF's. Studies that analyzed cardiac mortality concluded that there was no significant difference between HFmrEF and HFrEF, both of which were lower than HFpEF. Despite the significant increase of publications on HFmrEF, there is a great scarcity of prospective studies and clinical trials that allow delineating specific therapies for this new phenotype. To better treat HFmrEF patients, it is fundamental that cardiologists and internists understand the differences and similarities of this new phenotype.

Resumo Em 2016, a Sociedade Europeia de Cardiologia (ESC) reconheceu a insuficiência cardíaca (IC) com fração de ejeção do ventrículo esquerdo entre 40% e 49% como um novo fenótipo de IC, a IC com fração de ejeção intermediária (ICFEI), tendo como principal intuito, incentivar estudos sobre essa nova categoria. Em 2018, a Sociedade Brasileira de Cardiologia aderiu a essa classificação e introduziu a ICFEI no Brasil. O presente trabalho traz uma revisão narrativa sobre o que a literatura descreve até o momento sobre ICFEI. A prevalência de pacientes com ICFEI variou de 13-24% dos pacientes com IC. Quando avaliadas as características clínicas, a ICFEI apresenta um caráter intermediário ou se assemelha algumas vezes com a IC de fração de ejeção preservada (ICFEP) e outras com a IC de fração reduzida (ICFER). Quanto ao prognóstico, a ICFEI apresenta mortalidade por todas as causas semelhante a ICFEP e menor que a ICFER. Os estudos que analisaram a mortalidade por causa cardíaca concluíram que não houve diferença significativa entre ICFEI e ICFER, sendo ambas menores que a ICFEP. Apesar do considerável aumento de publicações sobre a ICFEI, ainda existe uma grande carência de estudos prospectivos e ensaios clínicos que possibilitem delinear terapias específicas para esse novo fenótipo. O conhecimento das particularidades da ICFEI por cardiologistas e internistas é fundamental para o melhor manejo desses pacientes.