ABSTRACT
INTRODUCTION: There are few data about the optimal use of natriuretic peptides (NP) in the Primary Care (PC) setting. The aim to assess how, through a common coordinated PC-hospital care pathway, the use of NPs in patients with suspected heart failure (HF) is improved. MATERIAL AND METHODS: Analytical, experimental, prospective, non-randomized study. An intervention group composed of 22 PC physicians from 2 health centers is provided with face-to-face training and a consensual protocol is attached with a cut-off point of NT-proBNP> 300 pg/mL as pathological. The control group is made up of the rest of PC physicians in the healthcare area. The aim is to compare the use and results of PN in both groups. Propensity analysis is performed so thar the patient populations with requested PN are comparable. RESULTS: From June 2021 to March 2022, NP was requested in 103 and 105 patients in the intervention/control groups. Both populations were similar, with equal HF risk. Symptomatology was present in 100% of intervention vs 41% of asymptomatic patients in the control group (p <0.001). ECG was performed in 100% vs 33.3%, p <0.001. Optimal NP indication in 76.7% vs 29.5%, p <0.001. In the intervention group more patients with NT-proBNP> 300 pg/mL are referred to cardiology consultations (76.6% vs 27.2%, p 0.001). CONCLUSION: The optimal indication for NP and its interpretation as a diagnostic tool for HF, in the PC setting seems not to be appropriate, but improvable with a coordinated and multidisciplinary intervention approach.
ABSTRACT
INTRODUCTION: The presence of anaemia leads to a worse prognosis in patients with heart failure (HF). There are few data on the impact of anaemia on mortality in patients with acute heart failure (AHF), and the studies available are mainly retrospective, and include hospitalised patients. OBJECTIVE: Evaluate the role of anaemia on 30-day and 1-year mortality in patients with AHF attended in hospital emergency departments (HEDs). METHODS: We performed a multicentre, observational study of prospective cohorts of patients with AHF. The study variables were: Anaemia (haemoglobin < 12g/dL in women and <13g/dL in men), mortality at 30 days and at 1 year, risk factors, comorbidity, functional impairment, basal functional grade for dyspnoea, chronic and acute treatment, clinical and analytical data of the episode, and patient destination. STATISTICAL ANALYSIS: Bivariate analysis and survival analyses using Cox regression. RESULTS: A total of 13 454 patients were included, 7662 (56.9%) of whom had anaemia. Those with anaemia were older, had more comorbidity, a worse functional status and New York Heart Association class, greater renal function impairment, and more hyponatraemia. The mortality was higher in patients with anaemia at 30 days and 1 year: 7.5% vs 10.7% (P < .001) and 21.2% vs 31.4% (P < .001), respectively. The crude and adjusted hazard ratios of anaemia for 30-day mortality were: 1.46 (confidence interval [CI] 95% 1.30-1.64); P < .001 and 1.20 (CI 95% 1.05-1.38); P = .009, respectively, and 1.57 (CI 95% 1.47-1.68) and 1.30 (CI 95% 1.20-1.40) for mortality at 1 year. The weight of anaemia on mortality was different in each follow-up period. CONCLUSIONS: Anaemia is an independent predictor of mortality at 30 days and 1 year in patients with AHF attended in HEDs. It is important to study the aetiology of AHF since adequate treatment would reduce mortality.
Subject(s)
Anemia , Heart Failure , Acute Disease , Anemia/complications , Anemia/epidemiology , Emergency Service, Hospital , Female , Heart Failure/complications , Humans , Male , Prognosis , Prospective Studies , Retrospective StudiesABSTRACT
Objetivos: La adrenomedulina (ADM) es un biomarcador cuyos niveles han demostrado tener valor pronóstico en diferentes patologías, particularmente en aquéllas de etiología infecciosa. Los niveles de la región medial de la proADM (RMproADM) son un reflejo de los de la ADM y tienen una mayor estabilidad plasmática. El objetivo de este estudio es analizar la relación entre los niveles de RMproADM y la gravedad de pacientes con disnea de origen respiratorio. Método: Estudio piloto, analítico, observacional, prospectivo y sin intervención de pacientes con disnea de origen respiratorio atendidos en un servicio de urgencias hospitalario (SUH). Se recogieron variables sociodemográficas, nivel de prioridad según el Sistema de Triaje de Manchester (STM) y variables relacionadas con su patología durante su asistencia en el SUH, incluidas las determinaciones analíticas. Se reservó parte del plasma para la posterior determinación de la RMproADM. Se hizo un seguimiento para ver el diagnóstico de alta, reingreso y fallecimiento en los 7 días tras la asistencia en el SUH. Como variables para medir la gravedad del proceso se utilizó el nivel de prioridad asignado por el STM. Resultados: Se incluyeron 50 pacientes [edad 69 (22) años y 52% hombres]. Veintiocho pacientes (56%) ingresaron y 17 (34%) tenían una prioridad 2 en el triaje. Los ingresados tenían una forma de presentación que los situaba en un nivel de gravedad superior a los que se iban de alta, mientras que no había diferencias en la mayoría de los parámetros medidos en el caso de la prioridad 2 del triaje comparados con las prioridades 3 y 4. Los niveles de RM-proADM eran mayores en los pacientes ingresados (..)(AU)
Background and objective: Adrenomedullin (ADM) is a prognostic biomarker that has proven useful in various diseases, particularly infections. The midregional proADM (MR-proADM) plasma concentration reflects the ADM level and is a more stable measure. This study aimed to explore the relationship between MR-proADM and severity of disease in patients with dyspnea due to respiratory disease. Patients and methods: Prospective, observational (no intervention), analytical pilot study in hospital emergency department patients with shortness of breath caused by respiratory disease. We recorded sociodemographic data, priority according to the Manchester triage system (MTS), and clinical data (including laboratory findings) collected in the emergency department. A plasma sample was reserved for later determination of MR-proADM concentration. The patients were followed for 7 days after the emergency department visit in order to record the discharge diagnosis,readmission, or exitus. The assigned MTS priority level was used as a measure of severity. Results: Fifty patients with a mean (SD) age of 69 (22) years were studied; 52% were men. Twenty-eight patients (56%)were admitted and 17 (34%) were assigned an MTS priority level of 2. The initial clinical picture indicated greater severity of disease in admitted patients than in discharged patients; the number of variables studied did not differ (AU) (..)
