Tendencias temporales en las características, tratamiento y resultados de la insuficiencia cardiaca en octogenarios durante dos décadas / Temporal trends in characteristics, treatment, and outcomes of heart failure in octogenarians over two decades

Introducción y objetivos Los octogenarios representan el segmento de población de más rápida expansión en Europa; la prevalencia de la insuficiencia cardiaca (IC) en este grupo supera el 10%. Se evaluaron los cambios en las características clínicas, el tratamiento y los resultados a un año durante dos décadas en pacientes ambulatorios con IC crónica de edad ≥ 80 años incluidos en un registro nacional de cardiología. Métodos Se incluyó a 2 520 octogenarios con mediciones de la fracción de eyección ecocardiográfica basal y seguimiento a 1 año disponibles, inscritos en 138 clínicas ambulatorias de IC (21% de los hospitales nacionales con unidades de cardiología), reclutados a lo largo de tres épocas (1999-2005, 2006-2011, 2012-2018). Resultados En el momento de la inclusión, a lo largo de los 3 periodos de estudio, aumentaron la edad, el índice de masa corporal, la fracción de eyección, la prevalencia de obesidad, diabetes, dislipemia, hipertensión preexistente y la historia de fibrilación auricular. La proporción de pacientes con fracción de eyección conservada aumentó del 19,4% al 32,7% (p de tendencia <0,0001). Los marcadores de enfermedad avanzada se hicieron menos prevalentes. La prescripción de bloqueadores beta y antagonistas de los receptores de mineralocorticoides aumentó con el tiempo. Durante el seguimiento a un año, 308 pacientes fallecieron (12,2%) y 360 (14,3%) fueron ingresados por causas cardiovasculares; en total, 591 (23,5%) alcanzaron el objetivo primario combinado de mortalidad por todas las causas u hospitalización cardiovascular. Mediante un análisis multivariable ajustado, la inclusión en 2006-2011 (HR=0,70; IC95%, 0,55-0,90; p=0,004) y 2012-2018 (HR=0,61; IC95%, 0,47-0,79; p=0,0002), conllevó un menor riesgo del resultado primario que la inclusión en el periodo 1999-2005. Conclusiones Entre los octogenarios, a lo largo de 2 décadas, la prevalencia de los factores de riesgo aumentó (AU)

Introduction and objectives Octogenarians represent the most rapidly expanding population segment in Europe. The prevalence of heart failure (HF) in this group exceeds 10%. We assessed changes in clinical characteristics, therapy, and 1-year outcomes over 2 decades in chronic HF outpatients aged ≥ 80 years enrolled in a nationwide cardiology registry. Methods We included 2520 octogenarians with baseline echocardiographic ejection fraction measurements and available 1-year follow-up, who were recruited at 138 HF outpatient clinics (21% of national hospitals with cardiology units), across 3 enrolment periods (1999-2005, 2006-2011, 2012-2018).Result At recruitment, over the 3 study periods, there was an increase in age, body mass index, ejection fraction, the prevalence of obesity, diabetes, dyslipidemia, pre-existing hypertension, and atrial fibrillation history. The proportion of patients with preserved ejection fraction rose from 19.4% to 32.7% (P for trend <.0001). Markers of advanced disease became less prevalent. Prescription of beta-blockers and mineralocorticoid receptor antagonists increased over time. During the 1-year follow-up, 308 patients died (12.2%) and 360 (14.3%) were admitted for cardiovascular causes; overall, 591 (23.5%) met the combined primary endpoint of all-cause mortality or cardiovascular hospitalization. On adjusted multivariable analysis, enrolment in 2006 to 2011 (HR, 0.70; 95%CI, 0.55-0.90; P=.004) and 2012 to 2018 (HR, 0.61; 95%CI, 0.47-0.79; P=.0002) carried a lower risk of the primary outcome than recruitment in 1999 to 2005. Conclusions Among octogenarians, over 2 decades, risk factor prevalence increased, management strategies improved, and survival remained stable, but the proportion hospitalized for cardiovascular causes declined. Despite increasing clinical complexity, in cardiology settings the burden of hospitalizations in the oldest old with chronic HF is declining (AU)

The 'real' woman with heart failure. Impact of sex on current in-hospital management of heart failure by cardiologists and internists.

AIM: To identify differences between sexes in the clinical profile, use of resources, management and outcome in a large population of 'real world' patients with heart failure (HF). METHODS: A prospective cross-sectional survey was conducted on 2127 consecutive patients (47% women) admitted with HF to 167 cardiology and 250 internal medicine departments between February 14 and 25, 2000. RESULTS: Women were older, had a higher prevalence of atrial fibrillation, and more frequently a hypertensive or valvular aetiology. Females were admitted more frequently in Medical than in Cardiology Departments. The rate of invasive and non-invasive procedures was lower in women than in men, slightly higher if managed by cardiologists. Women were less frequently prescribed ACE-inhibitors, amiodarone, and spironolactone, and more frequently prescribed digoxin. In-hospital mortality was similar, without difference between health-care providers. A 6-month follow-up was performed in 56.4% of the cases in both setting, but less frequently in women. Event rates were similar with nearly half of patients re-hospitalised at least once. CONCLUSION: The 'real' HF woman has generally a more severe disease; she is an old lady who is more frequently hospitalised in a medical unit, receives few diagnostic, and cardiovascular procedures and pharmacological therapy, has a relatively low probability of dying in hospital, but a high likelihood of requiring readmission.

Phosphorus runoff from incorporated and surface-applied liquid swine manure and phosphorus fertilizer.

Excessive fertilization with organic and/or inorganic P amendments to cropland increases the potential risk of P loss to surface waters. The objective of this study was to evaluate the effects of soil test P level, source, and application method of P amendments on P in runoff following soybean [Glycine max (L.) Merr.]. The treatments consisted of two rates of swine (Sus scrofa domestica) liquid manure surface-applied and injected, 54 kg P ha(-1) triple superphosphate (TSP) surface-applied and incorporated, and a control with and without chisel-plowing. Rainfall simulations were conducted one month (1MO) and six months (6MO) after P amendment application for 2 yr. Soil injection of swine manure compared with surface application resulted in runoff P concentration decreases of 93, 82, and 94%, and P load decreases of 99, 94, and 99% for dissolved reactive phosphorus (DRP), total phosphorus (TP), and algal-available phosphorus (AAP), respectively. Incorporation of TSP also reduced P concentration in runoff significantly. Runoff P concentration and load from incorporated amendments did not differ from the control. Factors most strongly related to P in runoff from the incorporated treatments included Bray P1 soil extraction value for DRP concentration, and Bray P1 and sediment content in runoff for AAP and TP concentration and load. Injecting manure and chisel-plowing inorganic fertilizer reduced runoff P losses, decreased runoff volumes, and increased the time to runoff, thus minimizing the potential risk of surface water contamination. After incorporating the P amendments, controlling erosion is the main target to minimize TP losses from agricultural soils.

Phosphorus runoff: effect of tillage and soil phosphorus levels.

Continued inputs of fertilizer and manure in excess of crop requirements have led to a build-up of soil phosphorus (P) levels and increased P runoff from agricultural soils. The objectives of this study were to determine the effects of two tillage practices (no-till and chisel plow) and a range of soil P levels on the concentration and loads of dissolved reactive phosphorus (DRP), algal-available phosphorus (AAP), and total phosphorus (TP) losses in runoff, and to evaluate the P loss immediately following tillage in the fall, and after six months, in the spring. Rain simulations were conducted on a Typic Argiudoll under a corn (Zea mays L.)-soybean [Glycine max (L.) Merr.] rotation. Elapsed time after tillage (fall vs. spring) was not related to any form of P in runoff. No-till runoff averaged 0.40 mg L(-1) and 0.05 kg ha(-1) DRP and chisel-plow plots averaged 0.24 mg L(-1) and 0.02 kg ha(-1) DRP concentration and loads, respectively. The relationship between DRP and Bray P1 extraction values was approximated by a logistic function (S-shaped curve) for no-till plots and by a linear function for tilled plots. No significant differences were observed between tillage systems for TP and AAP in runoff. Bray P1 soil extraction values and sediment concentration in runoff were significantly related to the concentrations and amounts of AAP and TP in runoff. These results suggest that soil Bray P1 extraction values and runoff sediment concentration are two easily measured variables for adequate prediction of P runoff from agricultural fields.