Frailty as a predictor of clinical problems and events that require elderly patients with heart failure to use health resources.

BACKGROUND: The clinical management of elderly patients with heart failure (HF) is not firmly established. Decision-making should be individualized depending on the biological deterioration of each patient, from aggressive management to a palliative approach. Frailty can serve as the basis for this comprehensive individualized management. Our objective was to evaluate the importance of the main clinical problems, as well as the events that required the use of health resources, based the degree of frailty, in elderly patients with HF. METHODS AND RESULTS: Retrospective observational cohort study. Frailty was defined according to the deficit accumulation construct. A total of 546 patients hospitalized for acute HF were included. The median age (Q1-Q3) was 82 (78-86) years. A total of 454 patients (83%) showed some degree of frailty: 221 (48.7%) mild, 207 (45.6%) moderate and 26 (5.7%) advanced. There was a significant tendency towards polypharmacy from no to severe frailty. Hospital events were recorded for 4 (1-6) patients with mild frailty, 4 (2-6) patients with moderate frailty and 2 ((1-4) patients with advanced frailty (p = 0.045). A total of 204 patients (37.4%) died during follow-up. The median time to death was 11.4 (4-16.8), 6.7 (3.3-11.6), 6.5 (3.4-12.2) and 4.1 (0.8-7.7) months for patients with no, mild, moderate, or advanced frailty, respectively (p = 0.006). CONCLUSIONS: Frailty due to deficit accumulation is a good predictor of clinical problems and events that require the use of health resources; therefore, it can serve as a basis for the management of HF in the elderly.

[An ileal ulcer and diaphragm-type colonic stenosis due to diclofenac]. / Ulcera ileal y estenosis colónica tipo diafragma por diclofenaco.

Nonsteroidal anti-inflammatory drugs (NSAID) are used extensively in the general population. It's well known the adverse effects of NSAID over the upper gastrointestinal tract and small intestine. Enteric-coated and slow release preparations were created in order to prevent those effects. We describe a woman case who took diclofenac for many years and developed both ileal ulceration and diaphragm-like colonic structure. Lesions in lower gastrointestinal tract were infrequent but severe; the lesion were seen on colonoscopy but not on barium studies; the physiopathology of these lesions remains uncertain; and the most efficacy attitude is the suppression of diclofenac.