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1.
Intern Emerg Med ; 16(1): 141-148, 2021 Jan.
Article in English | MEDLINE | ID: mdl-32557090

ABSTRACT

The objective of this study is to determine the prevalence of cognitive impairment (CogI) in patients hospitalized for congestive heart failure, and the influence of CogI on mortality and hospital readmission. This is a multicenter cohort study of patients hospitalized for congestive heart failure enrolled in the RICA registry. The patients were divided into 3 groups according to their Short Portable Mental Status Questionnaire score: 0-3 errors (no CogI or mild CogI), 4-7 (moderate CogI) and 8-10 (severe CogI). A total of 3845 patients with a mean (SD) age of 79 (8.6) years were included; 2038 (53%) were women. A total of 550 (14%) patients had moderate CogI and 76 (2%) had severe CogI. Factors independently associated with severe CogI were age (OR 1.09, 95% CI 1.05-1.14 p < 0.001), male sex (OR 0.57, 95% CI 0.34-0.95, p = 0.031), heart rate (OR 1.01, 95% CI 1.00-1.02, p = 0.004), Charlson index (OR 1.16, 95% CI 1.06-1.27, p = 0.002), and history of stroke (OR 2.67, 95% CI 1.60-4.44, p < 0.001). Severe CogI was associated with higher mortality after one year (HR 3.05, 95% CI 2.25-4.14, p < 0.001). The composite variable of death/hospital readmission was higher in patients with CogI (log rank p < 0.001). Patients with heart failure and severe CogI are older and have a higher comorbidity burden, lower survival, and a higher rate of death or readmission at 1 year, compared to patients with no CogI.


Subject(s)
Cognitive Dysfunction/epidemiology , Heart Failure/complications , Aged , Female , Heart Failure/mortality , Hospitalization , Humans , Male , Patient Readmission/statistics & numerical data , Prevalence , Psychiatric Status Rating Scales , Registries , Risk Factors , Spain/epidemiology
2.
Cardiology ; 135(3): 196-201, 2016.
Article in English | MEDLINE | ID: mdl-27428545

ABSTRACT

OBJECTIVE: The aim of this study was to determine whether patients with heart failure (HF) who recover left ventricular ejection fraction (LVEF), termed here as 'Rec-HF', have a distinct clinical profile and prognosis compared with patients with HF and reduced LVEF (HF-REF) or HF and preserved LVEF (HF-PEF). METHODS: We evaluated and classified patients from the Spanish Heart Failure Registry into three categories based on enrollment/follow-up echocardiograms: HF-PEF (LVEF ≥50%), HF-REF (LVEF persistently <50%) and Rec-HF (LVEF on enrollment <50% but normalized during follow-up). RESULTS: A total of 1,202 patients were included, 1,094 with HF-PEF, 81 with HF-REF and 27 with Rec-HF. The three groups included patients of advanced age (mean age 75 years) with comorbidities. Rec-HF patients were younger, with a better functional status, lower prevalence of diabetes mellitus, dementia and cerebrovascular disease, and higher prevalence of COPD. The etiology of HF was more frequently ischemic and alcoholic and less frequently hypertensive. After a median follow-up of 367 days, the unadjusted hazard ratios for death in the Rec-HF versus HF-PEF and HF-REF groups were 0.11 (95% CI 0.02-080; p = 0.029) and 0.31 (95% CI 0.04-2.5; p = 0.274). Results were statistically nonsignificant in multivariate-adjusted models. CONCLUSION: Rec-HF is also present in elderly patients with HF but it is necessary to further investigate the natural history and optimal pharmacologic management of this 'new HF syndrome'.


Subject(s)
Heart Failure/physiopathology , Stroke Volume , Ventricular Dysfunction, Left , Aged , Aged, 80 and over , Chronic Disease , Cohort Studies , Echocardiography , Heart Failure/diagnostic imaging , Humans , Middle Aged , Prognosis , Registries
3.
Med Clin (Barc) ; 125(20): 766-9, 2005 Dec 03.
Article in Spanish | MEDLINE | ID: mdl-16373025

ABSTRACT

BACKGROUND AND OBJECTIVE: We aimed to assess the prognostic importance of C-reactive protein (CRP) in the acute phase of ischemic stroke in-patients. PATIENTS AND METHOD: One hundred and seventeen patients within 48 h after index ischemic stroke were included. CRP levels and blood samples were obtained at this time, and a brain computerized tomography or magnetic resonance imaging were performed. Neurological and functional disability were evaluated and patients were divided according to the outcome into the following categories: transient ischemic attack, favorable stroke, and non-favorable stroke. RESULTS: 32 in-patients were classified as transient ischemic attack, 31 as favourable stroke, and 54 as non-favorable stroke. There was a worsening in neurological (p < 0.0001) and functional (p < 0.005) disabilities from the TIA group to non-favorable stroke. The CRP mean, by category, was 1.7, 1.07 and 3.6 mg/dl, respectively (p < 0.0001). CONCLUSIONS: We found increased levels of CRP in the non-favorable stroke category, that was related with neurological and functional disabilities, and with radiological findings, mainly when levels were greater than 3.6 (0.49) mg/dl.


Subject(s)
C-Reactive Protein/metabolism , Stroke/blood , Aged , Female , Humans , Male , Middle Aged , Prognosis
4.
Med. clín (Ed. impr.) ; 125(20): 766-769, dic. 2005. tab, graf
Article in Es | IBECS | ID: ibc-041759

ABSTRACT

Fundamento y objetivo: Valorar si los valores de proteína C reactiva (PCR) son de utilidad para definir el pronóstico de los pacientes con enfermedad cerebrovascular en fase aguda. Pacientes y método: Se ha estudiado a 117 sujetos con enfermedad cerebrovascular en fase aguda, a los que se realizaron determinaciones de PCR en las primeras 48 h tras el episodio, así como perfil lipídico y otras determinaciones hematológicas, junto con tomografía computarizada o resonancia magnética craneales. Se valoró a los pacientes mediante escalas de capacidad funcional y deterioro neurológico y se les clasificó en 3 grupos atendiendo al pronóstico clínico y funcional durante el ingreso (ataque isquémico transitorio, ictus favorables e ictus desfavorables). Resultados: Un total de 32 pacientes se clasificó como ataque isquémico transitorio, 31 como ictus favorables y 54 como ictus desfavorables. Cada grupo mostró menor capacidad funcional (p < 0,005) y mayor deterioro neurológico (p < 0,0001) a medida que empeoraba el pronóstico. La media de la PCR en cada grupo fue de 1,7, 1,07 y 3,6 mg/dl, respectivamente (p < 0,0001). Conclusiones: En nuestra muestra existen diferencias significativas en los valores de PCR entre los grupos con mejor y peor pronóstico que se relacionan con el grado de deterioro neurológico, capacidad funcional y extensión radiológica de la lesión principalmente cuando dichos valores medios (desviación estándar) son superiores a 3,6 (0,49) mg/dl


Background and objective: We aimed to assess the prognostic importance of C-reactive protein (CRP) in the acute phase of ischemic stroke in-patients. Patients and method: One hundred and seventeen patients within 48 h after index ischemic stroke were included. CRP levels and blood samples were obtained at this time, and a brain computerized tomography or magnetic resonance imaging were performed. Neurological and functional disability were evaluated and patients were divided according to the outcome into the following categories: transient ischemic attack, favorable stroke, and non-favorable stroke. Results: 32 in-patients were classified as transient ischemic attack, 31 as favourable stroke, and 54 as non-favorable stroke. There was a worsening in neurological (p < 0.0001) and functional (p < 0.005) disabilities from the TIA group to non-favorable stroke. The CRP mean, by category, was 1.7, 1.07 and 3.6 mg/dl, respectively (p < 0.0001). Conclusions: We found increased levels of CRP in the non-favorable stroke category, that was related with neurological and functional disabilities, and with radiological findings, mainly when levels were greater than 3.6 (0.49) mg/dl


Subject(s)
Male , Female , Humans , C-Reactive Protein/analysis , Stroke/physiopathology , Prospective Studies , Risk Factors , Prognosis
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