El colesterol total predice la mortalidad intrahospitalaria en pacientes de 70 años o mayores hospitalizados por insuficiencia cardiaca aguda / Total cholesterol levels predict in-hospital mortality in patients with acute heart failure aged 70 years or older

Introducción y objetivo. En insuficiencia cardiaca (IC) crónica y aguda, bajas concentraciones de colesterol total (CT) se han asociado con un incremento de la mortalidad. Este estudio pretende evaluar el impacto del CT sobre la mortalidad intrahospitalaria en pacientes de 70 años o mayores hospitalizados por IC aguda. Métodos. Los pacientes fueron divididos en 3 grupos según el valor de los cuartiles (Q) de CT (mg/dl): Q1 (CT ≤ 125), Q2-Q3 (CT: 126-174), Q4 (CT ≥ 175). Para valorar la asociación independiente de cada variable con la hipocolesterolemia y con la mortalidad intrahospitalaria se realizaron sendos análisis de regresión logística múltiple. Resultados. Se analizó a 301 pacientes. La edad media fue 79,3±5,5 años, el 51,2% presentaron una función sistólica deprimida y la etiología más frecuente fue la isquémica (40,9%). Se asociaron de forma independiente con la hipocolesterolemia una mayor proteína C reactiva, cifras menores de albúmina sérica y de hemoglobina y una menor fracción de eyección del ventrículo izquierdo. Durante el ingreso fallecieron 26 pacientes (8,6%). La mortalidad intrahospitalaria decreció progresivamente en cada cuartil del CT: Q1 14,3%, Q2-Q3 8,7% y Q4 2,7% (p=0,04), y se asoció de forma independiente con cifras mayores de creatinina sérica y menores de albúmina sérica y de CT. Conclusión. Cifras más bajas de CT predicen de forma independiente un incremento de la mortalidad intrahospitalaria en pacientes ancianos hospitalizados por IC aguda. Una mayor actividad inflamatoria, asociada a la hipocolesterolemia en este contexto clínico, podría explicar la asociación inversa entre colesterol y mortalidad (AU)

Introduction and purpose. Lower total cholesterol (TC) levels have been associated with increased mortality In both acute and chronic heart failure (HF) patients. The present study sought to evaluate the impact of TC levels on in-hospital mortality in patients with acute HF aged 70 years or older. Methods. Patients were divided into 3 groups based on TC (mg/dL) quartiles (Q) as follow: Q1 (CT≤125), Q2-Q3 (CT 126-174), Q4 (CT≥175). Multivariate logistic regression analysis was performed to assess the association of each variable with hypocholesterolaemia and in-hospital mortality. Results. The analysis included 301 patients with acute HF. The mean age was 79.3±5.5 years, and 51.2% of patients had HF with depressed systolic function, and the most frequent aetiology was ischaemic heart disease (40.9%). Higher C-reactive protein levels, lower levels of serum albumin and haemoglobin, and lower left ventricle ejection fraction were independently associated with hypocholesterolaemia. There 26 deaths (8.6% of the series) during hospitalization. In-hospital mortality decreased in a stepwise fashion with increasing quartile of TC: Q1 14.3%, Q2-Q3 8.7% and Q4 2.7% (P=.04), and was independently associated with higher serum creatinine levels and lower serum albumin and TC levels. Conclusions. Lower TC levels independently predict increased in-hospital mortality risk in older patients with acute HF. A higher inflammatory activity, associated with a lower total cholesterol in this clinical setting may explain the inverse relationship between cholesterol and mortality (AU)

[Total cholesterol levels predict in-hospital mortality in patients with acute heart failure aged 70 years or older]. / El colesterol total predice la mortalidad intrahospitalaria en pacientes de 70 años o mayores hospitalizados por insuficiencia cardiaca aguda.

INTRODUCTION AND PURPOSE: Lower total cholesterol (TC) levels have been associated with increased mortality In both acute and chronic heart failure (HF) patients. The present study sought to evaluate the impact of TC levels on in-hospital mortality in patients with acute HF aged 70 years or older. METHODS: Patients were divided into 3 groups based on TC (mg/dL) quartiles (Q) as follow: Q1 (CT≤125), Q2-Q3 (CT 126-174), Q4 (CT≥175). Multivariate logistic regression analysis was performed to assess the association of each variable with hypocholesterolaemia and in-hospital mortality. RESULTS: The analysis included 301 patients with acute HF. The mean age was 79.3±5.5 years, and 51.2% of patients had HF with depressed systolic function, and the most frequent aetiology was ischaemic heart disease (40.9%). Higher C-reactive protein levels, lower levels of serum albumin and haemoglobin, and lower left ventricle ejection fraction were independently associated with hypocholesterolaemia. There 26 deaths (8.6% of the series) during hospitalization. In-hospital mortality decreased in a stepwise fashion with increasing quartile of TC: Q1 14.3%, Q2-Q3 8.7% and Q4 2.7% (P=.04), and was independently associated with higher serum creatinine levels and lower serum albumin and TC levels. CONCLUSIONS: Lower TC levels independently predict increased in-hospital mortality risk in older patients with acute HF. A higher inflammatory activity, associated with a lower total cholesterol in this clinical setting may explain the inverse relationship between cholesterol and mortality.

Rationale and design of PICNIC study: nutritional intervention program in hospitalized patients with heart failure who are malnourished.

INTRODUCTION AND OBJECTIVES: Hospitalized patients with heart failure who are malnourished present a worse prognosis than those with an adequate nutritional status. It is unknown whether a nutritional intervention can modify the prognosis of these patients. The aim of this study is to assess the efficacy of a nutritional intervention on morbidity and mortality in hospitalized patients with heart failure who are malnourished. METHODS: PICNIC is a multicentre, randomized, controlled trial in which hospitalized patients with heart failure and malnutrition, as defined by the Mini Nutritional Assessment, are randomly assigned to conventional management of heart failure or conventional management of heart failure and an individualized nutritional intervention consisting of 3 points: optimization of diet, specific recommendations, and prescription, if deemed necessary, of nutritional supplements. A sample size of 182 patients for a maximum follow-up of 12 months has been estimated. The primary endpoint is time to death from any cause or rehospitalization because of heart failure. Analysis is by intention to treat. CONCLUSIONS: PICNIC study will determine the prognostic impact of a nutritional intervention in hospitalized patients with heart failure who are malnourished.

Justificación y diseño del estudio PICNIC: Programa de Intervención Nutricional en pacientes hospitalizados por Insuficiencia Cardiaca desnutridos / Rationale and Design of PICNIC Study: Nutritional Intervention Program in Hospitalized Patients With Heart Failure Who Are Malnourished

Introducción y objetivos: Los pacientes hospitalizados por insuficiencia cardiaca en estado de desnutrición tienen un pronóstico más desfavorable que los que están en adecuado estado nutricional. Se desconoce si una intervención nutricional puede modificar el pronóstico de estos pacientes. El objetivo de este estudio es evaluar si una intervención nutricional sobre pacientes hospitalizados con insuficiencia cardiaca desnutridos produce beneficio en su morbimortalidad. Métodos: PICNIC es un ensayo clínico multicéntrico, aleatorizado y controlado, en el que se asigna aleatoriamente a los pacientes hospitalizados por insuficiencia cardiaca aguda que además estén en estado de desnutrición, definido según la puntuación de la encuesta Mini Nutritional Assessment, a tratamiento convencional de la insuficiencia cardiaca o a tratamiento convencional de la insuficiencia cardiaca más una intervención nutricional individualizada que consta de tres puntos: optimización de la dieta, recomendaciones específicas y prescripción, si se estima necesario, de suplementos nutricionales. Se ha estimado un tamaño muestral de 182 pacientes para un periodo máximo de seguimiento de 12 meses. La variable principal del estudio será el tiempo hasta la muerte por cualquier causa o reingreso por insuficiencia cardiaca. El análisis se realiza por intención de tratar. Conclusiones: El estudio PICNIC determinará el impacto pronóstico de una intervención nutricional en pacientes hospitalizados con insuficiencia cardiaca desnutridos (AU)

Introduction and objectives: Hospitalized patients with heart failure who are malnourished present a worse prognosis than those with an adequate nutritional status. It is unknown whether a nutritional intervention can modify the prognosis of these patients. The aim of this study is to assess the efficacy of a nutritional intervention on morbidity and mortality in hospitalized patients with heart failure who are malnourished. Methods: PICNIC is a multicentre, randomized, controlled trial in which hospitalized patients with heart failure and malnutrition, as defined by the Mini Nutritional Assessment, are randomly assigned to conventional management of heart failure or conventional management of heart failure and an individualized nutritional intervention consisting of 3 points: optimization of diet, specific recommendations, and prescription, if deemed necessary, of nutritional supplements. A sample size of 182 patients for a maximum follow-up of 12 months has been estimated. The primary endpoint is time to death from any cause or rehospitalization because of heart failure. Analysis is by intention to treat. Conclusions: PICNIC study will determine the prognostic impact of a nutritional intervention in hospitalized patients with heart failure who are malnourished (AU)

Efectividad de la anticoagulación oral en la fibrilación auricular no valvular según el score CHA2DS2-VASc en pacientes con riesgo embólico bajo-intermedio / Effectiveness of oral anticoagulation in nonvalvular atrial fibrillation according to CHA 2DS2-VASc score in patients with low-moderate embolic risk

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