RESUMEN
In the original publication, the given name and family name of the fifth author Dr Margherita Migone De Amicis were incorrectly published. The correct given name and family name should read as 'Margherita' and 'Migone De Amicis', respectively.
RESUMEN
Chronic obstructive pulmonary disease (COPD) is a frequent comorbidity in heart failure (HF) patients. Whether a prior COPD diagnosis influences patients' prognosis in early stages of HF is unknown. We reviewed patients > 50 years old admitted because of a first episode of acute HF. We divided the sample into two groups according to the existence of a prior diagnosis of COPD. We used regression analysis to identify the baseline patients' characteristics associated with the presence of COPD, and Cox mortality analysis to identify baseline and discharge data related to higher risk of a combined outcome of 1-year all-cause readmission or mortality. Finally, 985 patients were included in the analysis; 212 (21.5%) with a prior diagnosis of COPD. Baseline characteristics were similar between both groups except for a much higher prevalence of male gender, higher number of chronic therapies, and lower prevalence of atrial fibrillation among COPD patients. The combined primary outcome is significantly more prevalent in COPD patients (68.4 vs. 59.8%, p = 0.022). Cox analysis identified this prior diagnosis of COPD (HR 1.282, 95% CI 1.063-1.547; p = 0.001) as an independent risk factor for 1-year readmission and mortality, together with older age, higher admission creatinine and potassium values, and a higher number of chronic therapies. Our study confirms that in a "real-life" cohort of elderly patients experiencing a first episode of acute HF, the presence of a prior diagnosis of COPD is common, and confers a higher risk of adverse outcomes (death or readmission) during the year following discharge.
Asunto(s)
Insuficiencia Cardíaca/mortalidad , Hospitalización/tendencias , Pronóstico , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Antagonistas Adrenérgicos beta/uso terapéutico , Anciano , Anciano de 80 o más Años , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Estudios de Cohortes , Femenino , Insuficiencia Cardíaca/terapia , Humanos , Masculino , Antagonistas de Receptores de Mineralocorticoides/uso terapéutico , Readmisión del Paciente/estadística & datos numéricos , Readmisión del Paciente/tendencias , Prevalencia , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Factores de RiesgoRESUMEN
Resumen Objetivos: Describir y analizar las características clínicas de la insuficiencia cardiaca en el anciano, así mismo, la influencia en la mortalidad según su fracción de eyección ventricular izquierda. Método: Estudio ecológico multigrupo descriptivo en 115 pacientes hospitalizados por la insuficiencia cardiaca aguda con un período de seguimiento de un año. Según la fracción de eyección ventricular izquierda los pacientes se dividieron en dos grupos (fracción de eyección ventricular izquierda preservada y no preservada, si presentaban ≥ 50% o < 50%, respectivamente). Se recogió la tasa de mortalidad al año del alta hospitalaria y se realizó un análisis de Cox de mortalidad. Resultados: La edad media fue de 83,9 años y el 40% fueron hombres. En 76 (66%) pacientes la fracción de eyección ventricular izquierda era preservada. Al año, 35 pacientes (30,4%) fallecieron. En el grupo de la fracción de eyección ventricular izquierda preservada predominaron más las mujeres y presentaron más comorbilidades como: la hipertensión arterial, la diabetes mellitus, la fibrilación auricular y la enfermedad pulmonar obstructiva crónica y por otro lado presentaron menos cardiopatía isquémica. Aunque la mortalidad era mayor en el grupo de la fracción de eyección ventricular izquierda no preservada, no se alcanzaba significación estadística (38,5% vs. 26,3%; p = 0,180). Conclusiones: La mortalidad al año de los pacientes ancianos con insuficiencia cardiaca es alta, así mismo tienen una mayor proporción de la fracción de eyección ventricular izquierda preservada, que a la vez asocia un mayor número de comorbilidades y una tendencia a mayor supervivencia al año con respecto a la fracción de eyección ventricular izquierda no preservada.
Abstract Motivation: To describe and analise the clinical features of heart failure in the elderly, as well as the influence in mortality according to their left ventricular ejection fraction. Method: Ecological multigroup descriptive study in 115 patients who had been hospitalised due to acute heart failure with a one year follow-up period. Depending on their left ventricular ejection fraction, patients were divided into two groups: preserved or non preserved left ventricular ejection fraction, if they showed ≥ 50% or <50%, respectively. Mortality rate one year after discharge was registered and Cox regression model was used for survival analysis. Results: Average age was 83.9 years and 40% were men. The left ventricular ejection fraction was preserved in 76 (66%) of patients. 35 (30.4%) died after one year. The preserved left ventricular ejection fraction group consisted of women predominantly, and they had more comorbidities, such as high blood pressure, diabetes mellitus, atrial fibrillation and chronic obstructive pulmonary disease, whereas their incidence of myocardial ischemia was lower. Despite mortality being higher in the non preserved left ventricular ejection fraction group, statistical significance was not reached (38.5% vs. 26.3%; p = 0.180). Conclusions: Mortality rate after one year of old patients with heart failure is high, and they also have a higher proportion of preserved left ventricular ejection fraction, which in turn is associated to a higher number of comorbidities and a higher tendency to survival after one year in comparison to non preserved left ventricular ejection fraction.