ABSTRACT
BACKGROUND: Heart failure (HF) is usually accompanied by cardiovascular and non-cardiovascular comorbidities, which may significantly impact its prognosis. In this study we aimed to characterize the comorbidity profile and its impact in mortality in patients with HF diagnosis from the Colombian Heart Failure Registry (RECOLFACA). METHODS: RECOLFACA enrolled adult patients with HF diagnosis from 60 centers in Colombia during the period 2017-2019. The primary outcome was all-cause mortality. A Cox proportional hazards regression model was used to assess the impact of the comorbidities in mortality. A p-value of <0.05 was considered significant. RESULTS: From the total 2528 patients included in the registry, 2514 patients (58% males, mean age 68 years) had information regarding comorbidity diagnoses. 2321 patients (92.3%) reported at least one comorbidity. Arterial hypertension was the most frequent individual diagnosis (72%; n = 1811), followed by anemia (30.1%, n = 726). The most frequently observed coexisting comorbidities were coronary disease (CHD) with dyslipidemia, and chronic kidney disease (CKD) with type 2 Diabetes Mellitus (T2DM). Different patterns of comorbidity coexistence were observed when comparing HF patients by sex and left-ventricular ejection fraction (LVEF) classification. The only comorbidities that were significantly associated with mortality after multivariate adjustment were T2DM (HR 1.45. 95% CI 1.01-2.12), anemia (HR 1.48. 95% CI 1.02-2.16), and CHD (HR 1.59. 95% CI 1.09-2.33). CONCLUSION: Multiple comorbidities were frequently observed in the patients from the RECOLFACA. T2DM, anemia and CHD were significantly associated with a higher risk of mortality, highlighting the importance of promoting an optimal follow-up and control of these conditions.
Subject(s)
Anemia , Coronary Artery Disease , Diabetes Mellitus, Type 2 , Heart Failure , Male , Adult , Humans , Aged , Female , Colombia/epidemiology , Stroke Volume , Ventricular Function, Left , Latin America , Comorbidity , Heart Failure/diagnosis , Heart Failure/epidemiology , Chronic Disease , RegistriesABSTRACT
We aimed to describe and compare characteristics and outcomes of patients with a worsening heart failure episode included in the RECOLFACA registry during 2017-2019 vs population from VICTORIA trial. 2528 patients were included, 1890 (74.8%) had an ejection fraction <45% and a worsening episode. VICTORIA population was similar to RECOLFACA patients in mean age (67.3 vs 66.9 years), ejection fraction (28.9% vs 28.4%), the prevalence of COPD (17.1% vs 15.7%), and the median eGFR (61.5 vs 61.4 mL/min/1.73m2). RECOLFACA patients were mostly women, with a lower prevalence of atrial fibrillation, diabetes mellitus, and coronary artery disease. The 1-year heart failure hospitalization rate was 29.6% in the placebo group of VICTORIA, compared to 26.9% in RECOLFACA. Patients enrolled in the RECOLFACA that met the VICTORIA definition had more similar characteristics and outcomes compared to the VICTORIA population. There is an opportunity to improve this unmet need with the use of vericiguat.
Subject(s)
Atrial Fibrillation , Heart Failure , Aged , Colombia , Female , Humans , Male , Registries , Stroke VolumeABSTRACT
Background: The Yang Tobin Index (Y/T) is a simple and objective measure to predict successful extubation. There are no Colombian studies supporting the use of Y/T as a predictor of successful ventilator weaning. Objective: To estimate the sensitivity and specificity of Y/T as predictor of weaning and to evaluate the association with clinical and socio-demographic characteristics in adult patients at the intensive care unit. Methods: Retrospective study. We analyzed a database of 332 records of patients under mechanical ventilation (MV) for more than 48 hours, from January 2006 to December 2007, with spontaneous breathing trial and measurement of Y/T before extubation. Results: The sensitivity of Y/T was 98.6%, specificity 9.6%, positive predictive value 85.4%, negative predictive value 55.5%. The cumulative incidence of successful extubation was 84%. The greater incidence of unsuccessful extubation was associated with COPD (46.2%). The MV time period showed a direct proportional relationship with failed extubation (p=0.186). Conclusions: The Y/T index is not a good predictor of success of extubation in the study population. No association was found between clinical and sociodemographic characteristics of the population, with respect to the sensitivity and specificity of the Y/T as a predictor of success.
Introducción: El índice Yang Tobin (Y/T), es una medida sencilla y objetiva para predecir éxito en la extubación. A nivel nacional no existen estudios que sustenten el uso del índice como predictor de éxito de extubación. Objetivos: Estimar la sensibilidad y especificidad del índice de Y/T y evaluar la relación con las características clínicas y demográficas en pacientes adultos en una unidad de cuidado intensivo. Métodos: Estudio retrospectivo; se analizó la información consignada en 332 formatos de ventilación mecánica de los pacientes que recibieron soporte ventilatorio invasivo por más de 48 horas desde enero de 2006 a diciembre de 2007, con prueba de respiración espontánea y medición del índice Y/T antes de la extubación. Resultados: La sensibilidad del Y/T fue 98.6%, especificidad 9.6%, valor predictivo positivo 85.4%, valor predictivo negativo 55.5%. La incidencia acumulada de extubación exitosa fue 84%. La mayor incidencia acumulada de extubación no exitosa se asoció con EPOC (46.2%). El tiempo de ventilación mecánica mostró una relación directamente proporcional con extubación no exitosa (p=0.186). Conclusiones: El índice Y/T no es un buen predictor de éxito de la extubación en la población de estudio. No se encontró asociación entre características clínicas y sociodemográficas de la población, con respecto a la sensibilidad y especificidad del Y/T como predictor de éxito.