Heart Failure in Outpatients: Comorbidities and Management by Different Specialists. The EPISERVE Study

González-Juanàtey, José Ramón; Ezquerra, Eduardo Alegría; Martínez, Vicente Bertoméu; Gutiérrez, Pedro Conthe; Nocito, Ana de Santiago; Fradera, Ilonka Zsolt

doi:10.1016/s1885-5857(08)60185-1

Cited by 35 publications

(22 citation statements)

References 34 publications

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“…Prevalence of HT was 55-76% of heart failure population in previous studies (10)(11)(12). Our population had similar prevalence rate of HT with above mentioned studies.…”

Section: Discussionsupporting

confidence: 86%

Ischemic stroke history predicts increased cardiovascular mortality in chronic heart failure

Kozdağ¹,

Yaymaci²,

İşeri³

et al. 2011

Anadolu Kardiyol Derg

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ÖZETAmaç: Kronik kalp yetersizliği (KKY) hastalarında kardiyak mortalite ve tekrarlayan hastaneye yatışları öngören komorbidite durumları araştırmak. Yöntemler: Hafif, orta ve ciddi (NYHA sınıfı II-IV) KKY'li 580 hasta (ortalama yaş 63±13 yıl, 373 erkek, 207 kadın, ortalama ejeksiyon fraksiyon (EF) %26±9) bu prospektif gözlemsel çalışmaya dahil edildi. Çalışmamızda dekompanse kalp yetersizliği nedeniyle Ocak 2003 ve Temmuz 2009 tarihleri arasında Kocaeli Üniversitesi, Tıp Fakültesi hastanesine yatırılan KKY'li hastalarda mevcut olan tüm komorbidite durumları; iskemik inme, koroner arter hastalığı, periferik arter hastalığı, kronik obstrüktif akciğer hastalığı, hipertansiyon, diyabetes mellitus ve kronik böbrek yetersizliği öyküsünü değerlendirdik. İstenmeyen sonlanım olayların öngödürücüleri Cox regresyon ve Kaplan-Meier sağkalım analizleri ile belirlendi. Bulgular: Toplam 580 hastadan 207 (%36) hasta kardiyovasküler nedenlerden dolayı öldü. Çoklu Cox regresyon analizinde yaş ( HR-1.06, %95 GA %95 GA 1.04-1.08, p<0.001), NYHA fonksiyonel kapasite, (HR-3.20, %95 GA 1.90-5.41, p<0.001), iskemik inme öyküsü (HR-2.48,%95 GA 1.14-5.37, p=0.022), hs-CRP (HR-1.09, %95 GA 1.04-1.15, p=0.001), BNP (HR-1.00, %95 GA 1.00-1.00, p=0.01) ve hemoglobin (HR-0.90, %95 GA 0.81-0.99, p=0.038) kardiyak ölüm için bağımsız öngördürücü olarak saptandı. KKY'li hastalarda iskemik inme öyküsü diğer komorbidite durumlara göre ABSTRACT Objective: To investigate comorbidities that predict cardiac mortality and re-hospitalization in chronic heart failure (CHF) patients. Methods: Five hundred eighty patients (mean age 63±13 years, 373 male, 207 female, mean ejection fraction (EF) 26±9%) with mild, moderate or severe CHF [NYHA class II-IV] were included in this prospective observational study. We evaluated all comorbidities such as history of ischemic stroke, coronary artery disease, peripheral arterial disease, chronic obstructive lung disease, hypertension, diabetes mellitus and chronic kidney disease in CHF patients who were hospitalized due to decompensated heart failure in Kocaeli University, Faculty of Medicine's Hospital between January 2003 and July 2009. Cox regression and Kaplan-Meier survival analyses were used to establish predictors of unfavorable outcomes. Results: Of 580 patients 207 (36%) patients died due to cardiovascular reasons. In multivariable Cox regression analysis age (HR-1.06, 95% CI 1.04-1.08, p<0.001), NYHA functional class (HR-3.20 95% CI, 1.90-5.41, p<0.001), history of ischemic stroke (HR-2.48, 95% CI 1.14-5.37, p=0.022), high-sensitive C-reactive protein (HR-1.09, 95% CI, 1.04-1.15, p=0.001), brain natriuretic peptide (HR-1.00, 95% CI 1.00-1.00, p=0.01) and hemoglobin p=0.038) were independent predictors of cardiac death in the present study. History of ischemic stroke was demonstrated as an important comorbidity that predicts cardiovascular mortality beyond other co-morbidities in CHF patients. NYHA functional class (HR-2.85, 95% CI 1.80-4.65, p<0.001), left ventricular EF p=0.039) and ischemic stroke histor...

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“…Prevalence of HT was 55-76% of heart failure population in previous studies (10)(11)(12). Our population had similar prevalence rate of HT with above mentioned studies.…”

Section: Discussionsupporting

confidence: 86%

Ischemic stroke history predicts increased cardiovascular mortality in chronic heart failure

Kozdağ¹,

Yaymaci²,

İşeri³

et al. 2011

Anadolu Kardiyol Derg

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“…Comorbidity complicates HF care and is prevalent in one form or another for the majority of elderly patients scheduled for CRT. This wide range of comorbidities, which includes diabetes and renal dysfunction, contributes to the progression of HF and may alter the response to treatment [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Cardiac resynchronization therapy is effective even in elderly patients with comorbidities

António

Lourenço

Teixeira

et al. 2009

J Interv Card Electrophysiol

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Purpose The purpose of this study was to compare the effects of cardiac resynchronization therapy (CRT) in elderly patients (≥65 years) with younger patients and to assess the impact of comorbidities in CRT remodeling response. Methods This is a prospective study of 87 consecutive patients scheduled for CRT who underwent clinical and echocardiographic evaluation before and 6 months after CRT. A reduction in left ventricular end-systolic volume (LVESV) ≥15% after CRT defined remodeling responders, and a reduction of at least one New York Heart Association class defined clinical responders. Multivariate analysis was used to identify independent predictors of non-response to CRT in terms of reverse remodeling. Results The mean age was 62±11 years, with 36 elderly patients (41%). The baseline QRS duration was 145± 32 ms. After CRT, there were significant and similar improvements of left ventricular (LV) ejection fraction, LVESV, LV dP/dt, and mitral regurgitation jet area (JA) between elderly (≥65 years) and younger (<65 years) patients. The number of clinical and remodeling responders was comparable, and we found no significant differences in unplanned cardiac hospitalizations at 6 months between groups. Independent predictors of lack of remodeling response to CRT were QRS duration <120 ms, LV diastolic diameter >74 mm, and JA >10 cm 2 before CRT, but not comorbidities.Conclusion This work suggests that being elderly is not an impediment to CRT success even in the presence of comorbidities.

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“…This group of patients had different characteristics from those of patients with HF-REF, including older population, higher proportion of women, and more frequent history of hypertension. In the present study, we demonstrated that short-term exposure to raised NO2 levels are an independent risk factor for admission to hospital for HF-PEF population, even superior to classical described predictors, such as age, sex, hypertension and left ventricular ejection fraction [21,22] . Despite the large body of evidence linking NO2 with daily mortality, few studies have addressed the issue of susceptibility to NO2 by performing analyses by age, sex, and chronic morbidity [6] .…”

Section: Discussionmentioning

confidence: 55%

Air pollution and heart failure: Relationship with the ejection fraction

Abreu-Afonso¹,

Rodrı́guez²,

Juarez-Prera³

et al. 2013

WJC

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Heart Failure in Outpatients: Comorbidities and Management by Different Specialists. The EPISERVE Study

Cited by 35 publications

References 34 publications

Ischemic stroke history predicts increased cardiovascular mortality in chronic heart failure

Ischemic stroke history predicts increased cardiovascular mortality in chronic heart failure

Cardiac resynchronization therapy is effective even in elderly patients with comorbidities

Air pollution and heart failure: Relationship with the ejection fraction

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