Análisis de la calidad de vida en pacientes con insuficiencia cardíaca mediante el cuestionario genérico SF-36 / Analysis of quality of life using the generic SF-36 questionnaire in patients with heart failure

Objetivo. La insuficiencia cardíaca es una de las principales enfermedades crónicas que afectan a la calidad de vida relacionada con la salud. El objetivo del presente estudio ha sido evaluar la calidad de vida en pacientes con clase funcional i - iii de la New York Heart Association mediante el cuestionario SF-36 usando una cohorte de supervivientes del Grupo de Estudio EPICOUR y compararlo con la calidad de vida de la población general española para el mismo sexo y grupo de edad. Material y métodos. Se diseñó un estudio de cohorte, observacional y prospectivo con los supervivientes del Grupo de Estudio EPICOUR a los que se les realizó control clínico-evolutivo y cuestionario SF-36. Resultados. Se estudió la calidad de vida en 50 pacientes (60% hombres). La edad media de los hombres fue de 64,8 años y de las mujeres de 68,3. Al analizar el SF-36 se observó que los resultados fueron más bajos en la esfera física que en la esfera mental. La calidad de vida empeoraba a medida que aumentaba la clase funcional. Al comparar los pacientes con la población general para el mismo sexo y edad, los pacientes con insuficiencia cardíaca mostraron puntuación inferior en todas las escalas (diferencias significativas en función física, dolor corporal, vitalidad y función social para los hombres y función física y rol emocional para las mujeres). Conclusiones. La insuficiencia cardíaca provoca un impacto negativo en la calidad de vida, tanto en la función física como en la función psicosocial, agravándose el deterioro con el incremento de la clase funcional(AU)

Objective: Heart failure is one of the major chronic diseases that affect health related quality of life. The objective of this study was to evaluate the quality of life in patients with New York Heart Association functional class i-iii using the SF-36 on a cohort of survivors of the EPICOUR Study Group and compare the quality of life with the general Spanish population of the same sex and age group. Material and methods: A cohort study, observational, and prospective study was conducted on survivors of the EPICOUR Study Group, on whom a clinical-progression-outcome review was performed along with the SF-36. Results: The quality of life was studied in 50 patients (60% male). The average age of men was 64.8 years and women 68.3. When analyzing the SF-36, it was observed that the results were lower in the physical dimensions than in the mental dimensions. The quality of life worsened with increasing functional class (statistically significant differences for scales of physical functioning, social functioning and borderline significance in mental health scale). When comparing patients with the general population of the same age and sex, patients with heart failure showed lower scores on all scales (significant differences in physical functioning, body pain, vitality, and social role for men, and physical function and emotional role for women). Conclusions: Heart failure causes a negative impact on quality of life, physical functioning, as well as psychosocial function, with the impairment becoming worse with increased functional class (AU)

[Analysis of quality of life using the generic SF-36 questionnaire in patients with heart failure]. / Análisis de la calidad de vida en pacientes con insuficiencia cardíaca mediante el cuestionario genérico SF-36.

OBJECTIVE: Heart failure is one of the major chronic diseases that affect health related quality of life. The objective of this study was to evaluate the quality of life in patients with New York Heart Association functional class I-III using the SF-36 on a cohort of survivors of the EPICOUR Study Group and compare the quality of life with the general Spanish population of the same sex and age group. MATERIAL AND METHODS: A cohort study, observational, and prospective study was conducted on survivors of the EPICOUR Study Group, on whom a clinical-progression-outcome review was performed along with the SF-36. RESULTS: The quality of life was studied in 50 patients (60% male). The average age of men was 64.8 years and women 68.3. When analyzing the SF-36, it was observed that the results were lower in the physical dimensions than in the mental dimensions. The quality of life worsened with increasing functional class (statistically significant differences for scales of physical functioning, social functioning and borderline significance in mental health scale). When comparing patients with the general population of the same age and sex, patients with heart failure showed lower scores on all scales (significant differences in physical functioning, body pain, vitality, and social role for men, and physical function and emotional role for women). CONCLUSIONS: Heart failure causes a negative impact on quality of life, physical functioning, as well as psychosocial function, with the impairment becoming worse with increased functional class.

Factores pronósticos de mortalidad de la insuficiencia cardíaca en una cohorte del noroeste de España. Estudio EPICOUR / Mortality prognosis factors in heart failure in a cohort of North-West Spain. EPICOUR study

Objetivos. La insuficiencia cardíaca (IC) supone un importante problema de salud pública, tanto por su elevada morbimortalidad como por el alto coste sanitario que provoca. Se realiza este estudio para estudiar la supervivencia de pacientes con IC en relación con la función ventricular y otros posibles factores de riesgo (FR) asociados con el pronóstico de la IC. Material y métodos. Estudio de cohortes, prospectivo, considerando como potenciales participantes a cualquier paciente hospitalizado por IC entre el 1 de enero de 1999 y el 31 de diciembre de 2002 (5.318 pacientes), a quien se le hubiese realizado ecocardiografía que mostrase disfunción sistólica ó diastólica (2.387 pacientes). Se eligió por muestreo aleatorio simple una muestra de 384 pacientes, transcurridos al menos 24 meses tras el episodio índice de hospitalización. La medición principal residió en la supervivencia y en las diferencias observadas en función de la fracción de eyección del ventrículo izquierdo, de la clase funcional (CF) de IC y de otras características clínicas y epidemiológicas. Se utilizaron las pruebas de Kaplan-Meier, del log-rank y de Cox. Resultados. La edad media fue de 74,84 años (rango: 36–95). 53,4% varones y 56,5% primer ingreso. El antecedente personal más frecuente fue hipertensión arterial (HTA) (59,9%), seguido de valvulopatía (41,9%) y enfermedad coronaria (EC) (26,8%). El 44,3% presentaban fibrilación-flutter auricular (FA). La supervivencia global observada a los 5 años fue de 47,9% y la específica por IC de 74,8%. No hubo diferencias significativas en supervivencia entre pacientes con insuficiencia cardíaca y función sistólica preservada (IC-FSP) y aquellos con disfunción sistólica (p=0,248). Son factores pronósticos de mortalidad por IC la CF basal previa al ingreso avanzada (Hazard ratio (HR) 5,37), el deterioro de filtrado glomerular (FG) (HR 0,98), la hipoalbuminemia (HR 0,59), la hiponatremia (HR 0,93), y la hiperpotasemia (HR 1,79). El índice de Castelli superior a 4,5 se halla en el límite de la significación estadística. Conclusiones. La supervivencia global observada a los 5 años es similar a la de otras series publicadas, siendo la específica por IC algo inferior, no habiendo diferencias en la supervivencia respecto a la fracción de eyección del ventrículo izquierdo (FEVI). Destacan como factores pronósticos de mortalidad por IC la hipoalbuminemia, la hiperpotasemia y el índice de Castelli elevado(AU)

Aims. Heart failure (HF) is a serious health problem in Spain because it has a high mortality rate and causes considerable costs to the health-care system. This paper presents a study made in the Spanish province of Ourense to study the survival of patients with HF related to the ventricular function or other possible risk factors (RF) associated with the HF prognosis. Material and methods. A prospective cohort study was performed, considering any patient hospitalized due to HF from 1 January 1999 to 31 December 2002 (5318 patients) who had undergone an echocardiography that showed systolic or diastolic dysfunction as potential participants (2387 patients). After at least 24 months of the index episode of hospitalization, a sample of 2384 patients was chosen by random sampling. The principal measurement was based on survival and the differences observed in the performance of the left ventricular ejection fraction, of functional class (FC) of HF and of other clinical and epidemiological characteristics. The Kaplan-Meier, log-rank and Cox tests were used. Results. Mean age of the patients 74.84 (range 36–95); 53.4% males and 56.5% first admission. The most common antecedent was arterial hypertension (HTA) (59.9%), followed by valvulopathy (41.9%) and heart disease (HD) (26.8%). A total of 44.3% of the patients had atrial fibrillation-flutter (AF). Global survival at 5 years was 47.9% and specific survival rate for HF was 74.8%. There were no significant differences in survival between patients with heart failure and preserved systolic function (HF-PSF) and those who suffered systolic dysfunction (p=0.248). Prognostic factors of mortality in patients with HF are: advanced functional class (class III–IV) prior to admission (Hazard ratio [HR] 5.37), deterioration of the glomerular filtration rate (GFR) (HR 0.98), hypoalbuminemia (HR 0.59), hyponatremia (HR 0.93) and hyperkalemia (HR 1.79). The Castelli index higher than 4.5 is in the limit of statistical significance. Conclusions. Global survival rate observed at 5 years of research is similar to the results found in already-published papers. Specific survival rate for HF is lower and there are no differences in the survival rate with regard to the left ventricle ejection fraction (Ef). However, we show that hypoalbuminemia, hyperkalemia and high Castelli index are important prognostic factors of mortality in patients with HF(AU)

[Mortality prognosis factors in heart failure in a cohort of North-West Spain. EPICOUR study]. / Factores pronósticos de mortalidad de la insuficiencia cardíaca en una cohorte del noroeste de España. Estudio EPICOUR.

AIMS: Heart failure (HF) is a serious health problem in Spain because it has a high mortality rate and causes considerable costs to the health-care system. This paper presents a study made in the Spanish province of Ourense to study the survival of patients with HF related to the ventricular function or other possible risk factors (RF) associated with the HF prognosis. MATERIAL AND METHODS: A prospective cohort study was performed, considering any patient hospitalized due to HF from 1 January 1999 to 31 December 2002 (5318 patients) who had undergone an echocardiography that showed systolic or diastolic dysfunction as potential participants (2387 patients). After at least 24 months of the index episode of hospitalization, a sample of 2384 patients was chosen by random sampling. The principal measurement was based on survival and the differences observed in the performance of the left ventricular ejection fraction, of functional class (FC) of HF and of other clinical and epidemiological characteristics. The Kaplan-Meier, log-rank and Cox tests were used. RESULTS: Mean age of the patients 74.84 (range 36-95); 53.4% males and 56.5% first admission. The most common antecedent was arterial hypertension (HTA) (59.9%), followed by valvulopathy (41.9%) and heart disease (HD) (26.8%). A total of 44.3% of the patients had atrial fibrillation-flutter (AF). Global survival at 5 years was 47.9% and specific survival rate for HF was 74.8%. There were no significant differences in survival between patients with heart failure and preserved systolic function (HF-PSF) and those who suffered systolic dysfunction (p=0.248). Prognostic factors of mortality in patients with HF are: advanced functional class (class III-IV) prior to admission (Hazard ratio [HR] 5.37), deterioration of the glomerular filtration rate (GFR) (HR 0.98), hypoalbuminemia (HR 0.59), hyponatremia (HR 0.93) and hyperkalemia (HR 1.79). The Castelli index higher than 4.5 is in the limit of statistical significance. CONCLUSIONS: Global survival rate observed at 5 years of research is similar to the results found in already-published papers. Specific survival rate for HF is lower and there are no differences in the survival rate with regard to the left ventricle ejection fraction (E(f)). However, we show that hypoalbuminemia, hyperkalemia and high Castelli index are important prognostic factors of mortality in patients with HF.

[Sleep apnea syndrome in heart failure. Effect of continuous positive airway pressure]. / Síndrome de apnea del sueño en la insuficiencia cardiaca. Efecto de la presión positiva continua en la vía aérea.

INTRODUCTION: Sleep disordered breathing and heart failure are common disorders that are frequently associated in the same patients which may bring on serious consequences. OBJECTIVE: To determine the prevalence of sleep apnea syndrome (SAS) in patients with controlled heart failure and the associated prevalence of arrhythmia. In addition, we to aim to evaluate the effectiveness of continuous positive airway pressure (CPAP) treatment for OSAS on left ventricular ejection fraction (EF). MATERIAL AND METHODS: We prospectively studied 60 patients (50 men, 10 women) with heart failure due to systolic dysfunction (left ventricular EF < 45%). All subjects were classified according the NYHA functional scale and received a specific questionnaire, as well as a home respiratory polygraphy and EKG Holter. A subject was considered to have SAS if their IAH > 15, and, according to standard recommendation, patients with IAH > 30 were treated with CPAP. After 3 months of treatment, the questionnaire, respiratory polygraphy and EKG Holter were repeated. RESULTS: Age was 69.3 +/- 10.4 years and the BMI was 28.5 +/- 4.74 kg/m2. Of the total sample, 55% (33 cases) were habitual snorers. The Epworth scale scores were 7.83 +/- 4.8. The EF was 36.3 +/- 7.4%, and 36 patients were NYHA class II, 23 were class III, and one patient was class IV. A total of 38 patients had SAS (63%): 14 (36%) had central sleep apnea and 24 (64%) had obstructive sleep apnea. EF revealed no significant differences between the SAS and non-SAS groups (36.42 +/- 7.6 vs. 35.81 +/- 6.6%, respectively). The SAS group presented a higher prevalence of bradicardia than the non-SAS group (24 % vs. 9%). After CPAP treatment, there was a significant improvement in EF (9%), in cases of obstructive sleep apnea, but no significant improvement was observed in patients with central sleep apnea. CONCLUSIONS: The prevalence of SAS in patients with heart failure due to systolic dysfunction is very high. CPAP treatment improved the EF in patients with obstructive sleep apnea.

Prueba de tuberculina en el control de salud. Importancia para diagnóstico de infección tuberculosa latente y/o tuberculosis pulmonar. Centro de Salud A Ponte / Tuberculin test in health control. Importance for the diagnosis of latent tuberculosis infection and/or pulmonary tuberculosis. Health Center A Ponte

Objetivos: Valorar la importancia de la prueba de tuberculina en el control de salud, para el diagnóstico de infección tuberculosa latente y tuberculosis pulmonar. Pacientes y métodos: Estudio retrospectivo de una cohorte de niños tuberculín-positivo, del Centro de Salud A Ponte. (Ourense). Resultados: Estudiamos a 52 niños con prueba de tuberculina positiva,; 14 menores de 5 años y 38 entre 5-15 años. Se diagnosticaron 46 infecciones tuberculosas latentes y 6 tuberculosis pulmonares. En el 69,5% (32) de las infecciones tuberculosas latentes el motivo de estudio fue control de salud y en 10 (21,7%) estudio de contactos. En los 6 niños con diagnóstico de tuberculosis pulmonar, el estudio se realizó en 3 por control de salud y en 2 por estudio de contactos. El 75,6% de los niños menores de 5 años resultaron infecciones tuberculosas latentes y el 21,4$ tuberculosis pulmonares; sin embargo, en el grupo de 5-15 años, el 92,1% fueron infecciones tuberculosas latentes, y 3 (7,9%) tuberculosis pulmonares. Conclusiones: La prueba de tuberculina realizada en el control del niño sano resultó una herramienta básica en el diagnóstico de infección tuberculosa latente y tuberculosis pulmonar en el Centro de Salud A. Ponte. Diagnosticó el 69,5% de las infecciones tuberculosas latentes y el 50% de las tuberculosis pulmonares de los niños estudiados (AU)

Objectives: To determine the importance of the tuberculin skin test in routine health checks on the diagnosis of the latent tuberculosis infection and pulmonary tuberculosis. Patients and methods: Retrospective study of at tuberculin positive children cohort, form the Primary Attention Center A. Ponte (Orense). Results: We have studied 52 children with a positive tuberculin skin test; 14 less than 5 years old and 38 between 5 and 15 years old. 46 latent tuberculosis infections and 6 pulmonary tuberculosis were diagnosed. In 32 (69,5%) of the latent tuberculosis infections the indication was a routine health check and in 10 (21.7%) the study of contact subjects. Of the 6 children with pulmonary tuberculosis diagnosis, 3 were studied in a routine health check and 2 for a contact study. 75,6% of children less than five years old were diagnosed of latent tuberculosis; however, in the 5 to 15 years old group, 92,1% were latent tuberculosis infections and 3 (7,9%) were pulmonary tuberculosis. Conclusions: The tuberculin skin test undertaken in the children routine health check resulted in a basic tool in the diagnosis of latent tuberculosis infection and pulmonary tuberculosis in the Primary Attention Center A Ponte (Ourense). It has diagnosed 69.5% of latent tuberculosis infection and 50% of pulmonary tuberculosis (AU)

Síndrome de apnea del sueño en la insuficiencia cardiaca. Efecto de la presión positiva continua en la vía aérea / Sleep apnea syndrome in heart failure. Effect of continuous positive airway pressure

Introducción: Los trastornos respiratorios durante el sueño (TRS) y la insuficiencia cardiaca (IC) son patologías muy comunes que con frecuencia se asocian en el mismo paciente con consecuencias que pueden ser graves. Objetivo: Conocer la prevalencia de síndrome de apnea del sueño (SAS) en pacientes con IC estable, arritmias asociadas, así como evaluar el efecto del tratamiento con presión positiva continua (CPAP) del SAS sobre la fracción de eyección de ventrículo izquierdo (FE). Material y métodos: Estudiamos de forma prospectiva a 60 pacientes (50 varones y 10 mujeres) con IC debida a disfunción sistólica (fracción de eyección del ventrículo izquierdo FE < 45%). A todos los pacientes se les realizó un cuestionario específico así como poligrafía respiratoria y un Holter en su domicilio. Se consideró la presencia de SAS cuando el IAH > 15 y aquellos con IAH > 30 fueron tratados con CPAP realizando los mismos estudios anteriores, poligrafía y Holter, a los 3 meses. Resultados: La edad fue de 69,3 ± 10,4 años y el índice de masa corporal (IMC) de 28,5 ± 4,74 kg/m 2. Un 55% (33 casos) eran roncadores habituarles y la puntuación en la escala Epworth era de 7,83 ± 4,8. La FE fue de 36,3 ± 7,4%, estando 36 enfermos en clase funcional II, 23 en clase funcional III y un enfermo en clase funcional IV. Un total de 38 pacientes tenían SAS (63%): 14 (36%) de tipo central y 24 (64%) de tipo obstructivo. La FE no mostró diferencias significativas entre el grupo SAS (36,4 ± 7,6) vs. (35,8 ± 6,6%) en el no-SAS. Los pacientes con SAS presentaron más frecuentemente bradicardia sinusal con respecto a los sujetos sin SAS (24% vs. 9%). Tras tratamiento con CPAP se observa una mejoría significativa de la FE de 9%, en los casos de SAS de predominio obstructivo, no observando cambios en los pacientes con SAS de predominio central. Conclusiones: La prevalencia de síndrome de apnea del sueño en pacientes con insuficiencia cardiaca y disfunción sistólica es muy alta. El tratamiento con CPAP mejora la fracción de eyección de los sujetos con SAS de carácter obstructivo

Introduction: Sleep disordered breathing and heart failure are common disorders that are frequently associated in the same patients which may bring on serious consequences. Objective: To determine the prevalence of sleep apnea syndrome (SAS) in patients with controlled heart failure and the associated prevalence of arrhythmia. In addition, we to aim to evaluate the effectiveness of continuous positive airway pressure (CPAP) treatment for OSAS on left ventricular ejection fraction (EF). Material and methods: We prospectively studied 60 patients (50 men,10 women) with heart failure due to systolic dysfunction (left ventricular EF < 45%). All subjects were classified according the NYHA functional scale and received a specific questionnaire, as well as a home respiratory polygraphy and EKG Holter. A subject was considered to have SAS if their IAH > 15, and, according to standard recommendation, patients with IAH > 30 were treated with CPAP. After 3 months of treatment, the questionnaire, respiratory polygraphy and EKG Holter were repeated. Results: Age was 69.3 ± 10.4 years and the BMI was 28.5 ± 4.74 kg/m2. Of the total sample, 55% (33 cases) were habitual snorers. The Epworth scale scores were 7.83 ± 4.8. The EF was 36.3 ± 7.4%, and 36 patients were NYHA class II, 23 were class III, and one patient was class IV. A total of 38 patients had SAS (63%): 14 (36%) had central sleepapnea and 24 (64%) had obstructive sleep apnea. EF revealed no significant differences between the SAS and non-SAS groups (36.42 ± 7.6 vs.35.81 ± 6.6%, respectively). The SAS group presented a higher prevalence of bradicardia than the non-SAS group (24 % vs. 9%). After CPAP treatment, there was a significant improvement in EF (9%), in cases ofobstructive sleep apnea, but no significant improvement was observed in patients with central sleep apnea. Conclusions: The prevalence of SAS in patients with heart failuredue to systolic dysfunction is very high. CPAP treatment improved the EF in patients with obstructive sleep apnea