Multidisciplinary approach to patients with heart failure and kidney disease: preliminary experience of an integrated cardiorenal unit.

Background: Cardiorenal programs have emerged to improve the management of cardiorenal disease (CRD). Evidence about the benefits of these programs is still scarce. This work aims to evaluate the performance of a novel cardiorenal program and describe the clinical profile and outcomes of patients with CRD. Methods: We conducted a retrospective observational study of patients with CRD attended in a cardiorenal unit (CRU) from February 2021 to February 2022. Demographics and laboratory tests were collected and events (all-cause death and cardiovascular hospitalizations) were evaluated. Optimization of comorbidities and protective therapies was also assessed. Results: Eighty-two patients were included, with a mean age of 76.8 years [standard deviation (SD) 8.5] and 72% were men. A total of 58.5% (n = 47) had left ventricular ejection fraction <50%. The mean follow-up was 11 months (SD 4.0). Almost 54% of the patients (n = 44) required hospitalization, 30.5% for heart failure (HF) decompensation. Total hospitalizations significantly decreased after CRU inclusion: 0.70 versus 0.45 admissions/year (P < .02). Global mortality was 17.1% (n = 14). The percentage of patients with HF with reduced ejection fraction on quadruple therapy increased by 20%, and up to 60% of the patients were on three drugs. A total of 39% of the patients with HF and preserved ejection fraction started treatment with sodium-glucose co-transporter inhibitors. Hyperkalaemia required the use of potassium binders in 12.2% of the patients and treatment of secondary hyperparathyroidism was started in 42.7% and renal anaemia in 23.2%. Renal replacement therapy was initiated in 10% of the patients (n = 8). Conclusion: CRD confers a considerable risk of adverse outcomes. Cardiorenal programs may improve cardiorenal syndrome management by optimizing therapies, treating comorbidities and reducing hospitalizations.

Role of Early Assesment of Diuresis and Natriuresis in Detecting In-Hospital Diuretic Resistance in Acute Heart Failure.

Background and Purpose: European Guidelines recommend early evaluation of diuresis and natriuresis after the first administration of diuretic to identify patients with insufficient diuretic response during acute heart failure. The aim of this work is to evaluate the prevalence and characteristics of patients with insufficient diuretic response according to this new algorithm. Methods: Prospective observational single centre study of consecutive patients with acute heart failure and congestive signs. Clinical evaluation, echocardiography and blood tests were performed. Diuretic naïve patients received 40 mg of intravenous furosemide. Patients on an oupatient diuretic regimen received 2 times the ambulatory dose. The diuresis volume was assessed 6 h after the first loop diuretic administration, and a spot urinary sample was taken after 2 h. Insufficient diuretic response was defined as natriuresis <70 mEq/L or diuresis volume <600 ml. Results: From January 2020 to December 2021, 73 patients were included (59% males, median age 76 years). Of these, 21 patients (28.8%, 95%CI 18.4; 39.2) had an insufficient diuretic response. Diuresis volume was <600 ml in 13 patients (18.1%), and 12 patients (16.4%) had urinary sodium <70 mEq/L. These patients had lower systolic blood pressure, worse glomerular filtration rate, and higher aldosterone levels. Ambulatory furosemide dose was also higher. These patients required more frequently thiazides and inotropes during admission. Conclusion: The diagnostic algorithm based on diuresis and natriuresis was able to detect up to 29% of patients with insufficient diuretic response, who showed some characteristics of more advanced disease.

Hypoalbuminemia on admission in COVID-19 infection: An early predictor of mortality and adverse events. A retrospective observational study.

OBJECTIVES: Hypoalbuminemia is a negative acute phase reactant which has been associated with inflammatory response and poor outcome in infectious diseases. The aim of this study was to analyze the value of hypoalbuminemia on admission as a predictor of mortality and adverse events in COVID-19 patients. METHODS: We analyzed retrospective data from a cohort of 609 consecutive patients, with confirmed diagnosis of COVID-19, discharged from hospital (deceased or alive). Demographic characteristics, previous comorbidities, symptoms and laboratory findings on admission were collected. Comorbidities were assessed by Charlson-Age Comorbidity Index. RESULTS: Hypoalbuminemia on admission (<34 g/L) was more frequent in nonsurvivors than survivors (65.6% vs. 38%, p < 0.001) and was significantly associated with the development of sepsis, macrophage activation syndrome, acute heart failure, acute respiratory distress syndrome and acute kidney injury, regardless of Charlson-Age Comorbidity Index. Hypoalbuminemia was a predictor of mortality in multivariable Cox regression analysis (HR 1.537, 95% CI 1.050-2.250, p = 0.027), independently of Charlson-Age Index, gender, lymphocyte count <800/µL, creatinine, high-sensitivity C- reactive protein >8 mg/L, lactate dehydrogenase >250 U/L, bilateral infiltration on chest X-ray and q-SOFA ≥2. CONCLUSIONS: Hypoalbuminemia was an early predictor of in-hospital mortality in COVID-19, regardless of age, comorbidity and inflammatory markers. It also had significant association with severe adverse events, independently of Charlson-Age Comorbidity Index. Our results suggest that serum albumin determination on admission may help to identify patients with SARS-CoV-2 infection at high risk of developing potential life-threatening conditions and death.

OBJETIVOS: La hipoalbuminemia es un reactante de fase aguda negativo que ha sido asociado a la respuesta inflamatoria y mal resultado en enfermedades infecciosas. El objetivo de este estudio fue analizar el valor de la hipoalbuminemia en el momento del ingreso, como factor predictivo de mortalidad y episodios adversos en los pacientes de COVID-19. MÉTODOS: Analizamos los datos retrospectivos de una cohorte de 609 pacientes consecutivos, con diagnóstico confirmado de COVID-19, que abandonaron el hospital (fallecidos o vivos). Se recopilaron las características demográficas, comorbilidades previas, síntomas y hallazgos de laboratorio en el momento del ingreso. Las comorbilidades se asociaron al índice de comorbilidad de Charlson-Age. RESULTADOS: La hipoalbuminemia en el momento del ingreso (< 34 g/l) fue más frecuente en los no supervivientes que en los supervivientes (65,6 vs. 38%; p < 0,001) y estuvo significativamente asociada a desarrollo de sepsis, síndrome de activación macrofágica, insuficiencia cardiaca aguda, síndrome de distrés respiratorio agudo e insuficiencia renal aguda, independientemente del índice de comorbilidad de Charlson-Age. La hipoalbuminemia fue un factor predictivo de la mortalidad en el análisis multivariable de regresión de Cox (HR: 1,537; IC 95%: 1,050-2,250; p = 0,027), independientemente del índice de Charlson-Age, sexo, recuento linfocítico < 800/µl, creatinina, proteína C reactiva de alta sensibilidad > 8 mg/l, lactato deshidrogenasa > 250 U/l, infiltración bilateral en la placa de tórax y q-SOFA ≥ 2. CONCLUSIONES: La hipoalbuminemia fue un factor predictivo temprano de la mortalidad intrahospitalaria en la COVID-19, independientemente de la edad, de la comorbilidad y de los marcadores inflamatorios. También tuvo una asociación significativa con episodios adversos graves, independientemente del índice de comorbilidad de Charlson-Age. Nuestros resultados sugieren que determinar la albúmina sérica en el momento del ingreso podría ayudar a identificar a los pacientes con infección por SARS-CoV-2 con alto riesgo de desarrollar situaciones potencialmente mortales y muerte.

Hypoalbuminemia on admission in COVID-19 infection: An early predictor of mortality and adverse events. A retrospective observational study

Objectives: Hypoalbuminemia is a negative acute phase reactant which has been associated with inflammatory response and poor outcome in infectious diseases. The aim of this study was to analyze the value of hypoalbuminemia on admission as a predictor of mortality and adverse events in COVID-19 patients.MethodsWe analyzed retrospective data from a cohort of 609 consecutive patients, with confirmed diagnosis of COVID-19, discharged from hospital (deceased or alive). Demographic characteristics, previous comorbidities, symptoms and laboratory findings on admission were collected. Comorbidities were assessed by Charlson-Age Comorbidity Index.ResultsHypoalbuminemia on admission (<34g/L) was more frequent in nonsurvivors than survivors (65.6% vs. 38%, p<0.001) and was significantly associated with the development of sepsis, macrophage activation syndrome, acute heart failure, acute respiratory distress syndrome and acute kidney injury, regardless of Charlson-Age Comorbidity Index. Hypoalbuminemia was a predictor of mortality in multivariable Cox regression analysis (HR 1.537, 95% CI 1.050–2.250, p=0.027), independently of Charlson-Age Index, gender, lymphocyte count <800/μL, creatinine, high-sensitivity C- reactive protein >8mg/L, lactate dehydrogenase >250U/L, bilateral infiltration on chest X-ray and q-SOFA ≥2.ConclusionsHypoalbuminemia was an early predictor of in-hospital mortality in COVID-19, regardless of age, comorbidity and inflammatory markers. It also had significant association with severe adverse events, independently of Charlson-Age Comorbidity Index. Our results suggest that serum albumin determination on admission may help to identify patients with SARS-CoV-2 infection at high risk of developing potential life-threatening conditions and death. (AU)

Objetivos: La hipoalbuminemia es un reactante de fase aguda negativo que ha sido asociado a la respuesta inflamatoria y mal resultado en enfermedades infecciosas. El objetivo de este estudio fue analizar el valor de la hipoalbuminemia en el momento del ingreso, como factor predictivo de mortalidad y episodios adversos en los pacientes de COVID-19.MétodosAnalizamos los datos retrospectivos de una cohorte de 609 pacientes consecutivos, con diagnóstico confirmado de COVID-19, que abandonaron el hospital (fallecidos o vivos). Se recopilaron las características demográficas, comorbilidades previas, síntomas y hallazgos de laboratorio en el momento del ingreso. Las comorbilidades se asociaron al índice de comorbilidad de Charlson-Age.ResultadosLa hipoalbuminemia en el momento del ingreso (<34g/l) fue más frecuente en los no supervivientes que en los supervivientes (65,6 vs. 38%; p<0,001) y estuvo significativamente asociada a desarrollo de sepsis, síndrome de activación macrofágica, insuficiencia cardiaca aguda, síndrome de distrés respiratorio agudo e insuficiencia renal aguda, independientemente del índice de comorbilidad de Charlson-Age. La hipoalbuminemia fue un factor predictivo de la mortalidad en el análisis multivariable de regresión de Cox (HR: 1,537; IC 95%: 1,050-2,250; p=0,027), independientemente del índice de Charlson-Age, sexo, recuento linfocítico <800/μl, creatinina, proteína C reactiva de alta sensibilidad >8mg/l, lactato deshidrogenasa >250U/l, infiltración bilateral en la placa de tórax y q-SOFA ≥2. (AU)

Hypoalbuminemia on admission in COVID-19 infection: An early predictor of mortality and adverse events. A retrospective observational study.

OBJECTIVES: Hypoalbuminemia is a negative acute phase reactant which has been associated with inflammatory response and poor outcome in infectious diseases. The aim of this study was to analyze the value of hypoalbuminemia on admission as a predictor of mortality and adverse events in COVID-19 patients. METHODS: We analyzed retrospective data from a cohort of 609 consecutive patients, with confirmed diagnosis of COVID-19, discharged from hospital (deceased or alive). Demographic characteristics, previous comorbidities, symptoms and laboratory findings on admission were collected. Comorbidities were assessed by Charlson-Age Comorbidity Index. RESULTS: Hypoalbuminemia on admission (<34g/L) was more frequent in nonsurvivors than survivors (65.6% vs. 38%, p<0.001) and was significantly associated with the development of sepsis, macrophage activation syndrome, acute heart failure, acute respiratory distress syndrome and acute kidney injury, regardless of Charlson-Age Comorbidity Index. Hypoalbuminemia was a predictor of mortality in multivariable Cox regression analysis (HR 1.537, 95% CI 1.050-2.250, p=0.027), independently of Charlson-Age Index, gender, lymphocyte count <800/µL, creatinine, high-sensitivity C- reactive protein >8mg/L, lactate dehydrogenase >250U/L, bilateral infiltration on chest X-ray and q-SOFA ≥2. CONCLUSIONS: Hypoalbuminemia was an early predictor of in-hospital mortality in COVID-19, regardless of age, comorbidity and inflammatory markers. It also had significant association with severe adverse events, independently of Charlson-Age Comorbidity Index. Our results suggest that serum albumin determination on admission may help to identify patients with SARS-CoV-2 infection at high risk of developing potential life-threatening conditions and death.

Type 2 Diabetes Mellitus, Glycated Hemoglobin Levels, and Cardiopulmonary Exercise Capacity in Patients With Ischemic Heart Disease.

PURPOSE: Diabetes mellitus (DM) is associated with long-term cardiovascular complications, including ischemic heart disease (IHD). Nonetheless, DM may directly impair myocardial and lung structure and function. The aim of this study was to assess the impact of type 2 DM (T2DM) and glycemic control on cardiopulmonary exercise capacity in patients with IHD. METHODS: The study involved a cross-sectional analysis of 91 consecutive patients (57 ± 10 yr, 90% men) who underwent a cardiopulmonary exercise test at the beginning of an exercise-based standard phase-II cardiac rehabilitation program, 2 to 3 mo after an acute coronary syndrome. Association of T2DM with cardiopulmonary exercise test parameters was assessed using multiple linear regression analysis controlling for prespecified potential confounders. RESULTS: There were 26 (29%) diabetic subjects among IHD patients included in the study. After adjustment, T2DM was an independent predictor of a reduced peak oxygen uptake ((Equation is included in full-text article.)O2peak) (P = .005), a reduced pulse O2 trajectory (P = .001), a steeper minute ventilation to carbon dioxide output (VE/(Equation is included in full-text article.)CO2) slope (P = .046), and an increased dead space-to-tidal volume ratio (VD/VT) at peak exercise (P = .049). Glycated hemoglobin (HbA1c) levels were significantly associated with a reduced forced expiratory volume in the first second of expiration (FEV1) (P = .013), VE (P = .001), and VT (P = .007). (Equation is included in full-text article.)O2peak (P trend < .001), (Equation is included in full-text article.)O2 at anaerobic threshold (P trend < .001), and pulse O2 trajectory (P trend < .001) decreased among HbA1c tertiles. CONCLUSIONS: Patients with IHD and a previous diagnosis of T2DM had a reduced aerobic capacity and a ventilation- perfusion mismatch compared with nondiabetic patients. Poor glycemic control in men further deteriorates aerobic capacity probably due to ventilatory inefficiency.

[Mediterranean Spotted Fever: epidemiological Assessment in Spain during the Period 2009-2012]. / Fiebre botonosa mediterránea: epidemiología en España durante el periodo 2009-2012.

BACKGROUND: The Mediterranean Spotted Fever (MSF) is a zoonosis, produced by Rickettsia conorii whose vector is Rhipicephallus sanguineus. The aim of this study was to describe the epidemiology in Spain and its Autonomous Communities (AA.CC) and the average cost during the period 2009-2012. METHODS: We conducted a retrospective observational study of patients, between 2009-2012, whose diagnostic at hospital discharge was encoded, according to the International Classification of Diseases 9th revision Clinical Modification (ICD-9CM) as 82.1 (MSF). The information was collected through the minimum basic data set. Incidence rates of the disease were calculated in Spain and its Autonomous Communities. The fStats software was used for comparison of rates based on age, sex, annual, seasonal and AA.CC's distribution. The average cost (in euros) was calculated according to the state standard. RESULTS: The incidence rate was 0,36 cases per 100,000 inhabitants and year during 2009-2012, with 667 admissions. The highest incidence was obtained in Ceuta and La Rioja with an incidence of 1,9 and 1,87 cases per 100,000 inhabitants per year. No cases were detected in Cantabria nor Canarias. The relative risk male female was 2:1 (p value<0,05). The predominant age group was over 55 years (327 cases). The months with the most cases were from June to September (466 cases), producing a peak in the number of cases in August (137 cases). The mortality rate was 0,3%. The average cost was 4.647,205 €. CONCLUSION: The incidence of MSF was low, with a heterogeneous geographical distribution and with higher frequency during the month of August. Patients of all ages were detected, predominantly for males over 55 years old. The hospital mortality rate was small.

Fiebre botonosa mediterránea: epidemiología en España durante el periodo 2009-2012 / Mediterranean Spotted Fever: Epidemiological Assessment in Spain during the Period 2009-2012

Fundamento: La Fiebre Botonosa Mediterránea (FBM) es una zoonosis producida por Rickettsia conorii cuyo vector es Rhipicephallus sanguineus. El objetivo de este trabajo fue describir la epidemiología y el coste medio de la fiebre botonosa en España y sus comunidades autónomas durante el período 2009-2012). Métodos: Se realizó un estudio observacional del período 2009-2012 utilizando como fuente de información el Conjunto Mínimo de Datos (CMBD), identificando las altas hospitalaria cuyo diagnóstico, de acuerdo a la Clasificación Internacional de Enfermedades 9ª revisión Modificación Clínica (CIE-9MC) fue 82.1 (fiebre botonosa mediterránea). Se calcularon las tasas de incidencia de dicha enfermedad en España y cada una de las comunidades autónomas. El coste medio (en euros) se calculó de acuerdo a la norma estatal para grupos diagnósticos relacionados. Se utilizó el software fStats para la comparación de tasas según la edad, sexo, distribución anual, estacional y por CCAA. Resultados: Durante el período de estudio se identificaron 667 ingresos con diagnóstico al alta de fiebre botonosa mediterránea, siendo la tasa de incidencia fue de 0,36 casos por 100.000 habitantes. La mayor incidencia se dio en Ceuta y La Rioja con una incidencia de 1,9 y 1,87 casos por 100.000 habitantes y año. No se detectaron casos en Cantabria ni en Canarias. El riesgo relativo hombre/mujer fue 2:1 (valor de p<0,05). El grupo etario predominante fue el de los mayores de 55 años (327 casos). Los meses con más casos fueron de junio-septiembre (466 casos), produciéndose un pico de casos en agosto (137 casos). La tasa de mortalidad fue 0,3%. El coste medio fue de 4.647,205€. Conclusión: La incidencia de la fiebre botonosa mediterránea durante el período estudiado fue menor que en períodos anteriores, con una distribución por comunidades autónomas heterogénea y con mayor frecuencia durante el mes de agosto. Se detectaron pacientes de todas las edades, predominando los varones mayores de 55 años. La tasa de mortalidad intrahospitalaria fue pequeña (AU)

Background: The Mediterranean Spotted Fever (MSF) is a zoonosis, produced by Rickettsia conorii whose vector is Rhipicephallus sanguineus. The aim of this study was to describe the epidemiology in Spain and its Autonomous Communities (AA.CC) and the average cost during the period 2009-2012. Methods: We conducted a retrospective observational study of patients, between 2009-2012, whose diagnostic at hospital discharge was encoded, according to the International Classification of Diseases 9th revision Clinical Modification (ICD-9CM) as 82.1 (MSF). The information was collected through the minimum basic data set. Incidence rates of the disease were calculated in Spain and its Autonomous Communities. The fStats software was used for comparison of rates based on age, sex, annual, seasonal and AA.CC´s distribution. The average cost (in euros) was calculated according to the state standard. Results: The incidence rate was 0,36 cases per 100,000 inhabitants and year during 2009-2012, with 667 admissions. The highest incidence was obtained in Ceuta and La Rioja with an incidence of 1,9 and 1,87 cases per 100,000 inhabitants per year. No cases were detected in Cantabria nor Canarias. The relative risk male female was 2:1 (p value<0,05). The predominant age group was over 55 years (327 cases). The months with the most cases were from June to September (466 cases), producing a peak in the number of cases in August (137 cases). The mortality rate was 0,3%. The average cost was 4.647,205€. Conclusion: The incidence of MSF was low, with a heterogeneous geographical distribution and with higher frequency during the month of August. Patients of all ages were detected, predominantly for males over 55 years old. The hospital mortality rate was small (AU)