Background Increasing the knowledge about heart failure (HF) costs and their determinants is important to ascertain how HF management can be optimized, leading to a significant decrease of HF costs. This study evaluated the cumulative costs and healthcare utilisation in HF patients in Spain. Methods Observational, retrospective, population-based study using BIG-PAC database, which included data from specialized and primary care of people ≥18 years, from seven autonomous communities in Spain, who received care for HF between 2015 and 2019. The healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019. Results We identified 17,163 patients with HF (year 2015: mean age 77.3 ± 11.8 years, 53.5% men, 51.7% systolic HF, 43.6% on NYHA functional class II). During the 2015–2019 period, total HF associated costs reached 15,373 Euros per person, being cardiovascular disease hospitalizations the most important determinant (75.8%), particularly HF hospitalizations (51.0%). Total medication cost accounted for 7.0% of the total cost. During this period, there was a progressive decrease of cardiovascular disease hospital costs per year (from 2834 Euros in 2015 to 2146 Euros in 2019, P < 0.001), as well as cardiovascular and diabetic medication costs. Conclusions During the 2015–2019 period, costs of HF patients in Spain were substantial, being HF hospitalizations the most important determinant. Medication costs represented only a small proportion of total costs. Improving HF management, particularly through the use of drugs that reduce HF hospitalization may be helpful to reduce HF burden.

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Objective: To estimate the prevalence, incidence, and describe the characteristics and management of patients with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF) in Spain. Methods: Adults with ≥1 inpatient or outpatient HF diagnosis between 1 January 2013 and 30 September 2019 were identified through the BIG-PAC database. Annual incidence and prevalence by EF phenotype were estimated. Characteristics by EF phenotype were described in the 2016 and 2019 HF prevalent cohorts and outcomes in the 2016 HF prevalent cohort. Results: Overall, HF incidence and prevalence were 0.32/100 person-years and 2.34%, respectively, but increased every year. In 2019, 49.3% had HFrEF, 38.1% had HFpEF, and 4.3% had HFmrEF (in 8.3%, EF was not available). Compared with HFrEF, patients with HFpEF were largely female, older, and had more atrial fibrillation but less atherosclerotic cardiovascular disease. Among patients with HFrEF, 76.3% were taking renin-angiotensin system inhibitors, 69.5% beta-blockers, 36.8% aldosterone antagonists, 12.5% sacubitril/valsartan and 6.7% SGLT2 inhibitors. Patients with HFpEF and HFmrEF took fewer HF drugs compared to HFrEF. Overall, the event rates of HF hospitalization were 231.6/1000 person-years, which is more common in HFrEF patients. No clinically relevant differences were found in patients with HFpEF, regardless EF (50- < 60% vs. ≥60%). Conclusions: >2% of patients have HF, of which around 50% have HFrEF and 40% have HFpEF. The prevalence of HF is increasing over time. Clinical characteristics by EF phenotype are consistent with previous studies. The risk of outcomes, particularly HF hospitalization, remains high, likely related to insufficient HF treatment.

Aims To describe healthcare resource utilization (HCRU) of patients with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF) in Spain.  Methods Adults with ≥ 1 HF diagnosis and ≥ 1 year of continuous enrolment before the corresponding index date (1/January/2016) were identified through the BIG-PAC database. Rate per 100 person-years of all-cause and HF-related HCRU during the year after the index date were estimated using bootstrapping with replacement. Results Twenty-one thousand two hundred ninety-seven patients were included, of whom 48.5% had HFrEF, 38.6% HFpEF and 4.2% HFmrEF, with the rest being of unknown EF. Mean age was 78.8 ± 11.8 years, 53.0% were men and 83.0% were in NYHA functional class II/III. At index, 67.3% of patients were taking renin angiotensin system inhibitors, 61.2% beta blockers, 23.4% aldosterone antagonists and 5.2% SGLT2 inhibitors. Rates of HF-related outpatient visits and hospitalization were 968.8 and 51.6 per 100 person-years, respectively. Overall, 31.23% of patients were hospitalized, mainly because of HF (87.88% of total hospitalizations); HF hospitalization length 21.06 ± 17.49 days (median 16; 25th, 75th percentile 9–27). HF hospitalizations were the main cost component: inpatient 73.64%, pharmacy 9.67%, outpatient 9.43%, and indirect cost 7.25%. Rates of all-cause and HF-related HCRU and healthcare cost were substantial across all HF subgroups, being higher among HFrEF compared to HFmrEF and HFpEF patients. Conclusions HCRU and cost associated with HF are high in Spain, HF hospitalizations being the main determinant. Medication cost represented only a small proportion of total costs, suggesting that an optimization of HF therapy may reduce HF burden.

Slower speed gaits are observed across the spectrum of multimorbidity in older adults without functional dependency. The role of gait speed as a simple indicator to evaluate and monitor general health status in older populations is expanded to include older adults without dependency. Geriatr Gerontol Int 2018; 18: 293-300.

Para una aproximación real a la pluripatología y los problemas asociados del anciano, y analizar si la historia clínica convencional evalúa en forma adecuada a éste paciente, se realizó un estudio prospectivo, el primero en el país, en 71 pacientes de 60 años o más, hospitalizados en el HNCH entre Enero a Marzo de 1991. Se observó que a diferencia del adulto joven, nos enfrentamos no sólo a enfermedades, sino también a problemas asociados como: depresión 53.5%, ansiedad 50.7%, alteraciones en el sueño 81.7%, temblores 16.9%, caídas 67.6%, hipotensión ortástica (probable) 50.7%, incontinencia urinaria 42.3%, estreñimiento 32.4%, úlceras por presión 5.7%, trastornos de órganos sensoriales 83.1%. También se evidenció diferencia significativa entre lo observado por nosotros y lo registrado en la historia clínica convencional, fundamentalmente en lo concerniente a problemasasociados que generalmente no se consideran. Se plantea la necesidad de considerar estos aspectos durante la evaluación del geronto, así como de contar con una historia clínica geriátrica especialmente diseñada y orientada a enfermedades y problemas con el fin de brindar una adecuada atención al paciente geriátrico.

Objetivos. Determinar los factores asociados a velocidad de marcha lenta en adultos mayores de la comunidad residentes en un distrito de Lima, Perú. Materiales y métodos. Estudio de análisis de base de datos secundario. Se incluyó a los adultos mayores de 60 años y se excluyó aquellos con condiciones que no garantizaban la evaluación de la marcha. La variable dependiente fue la velocidad de marcha lenta, menor a 1 m/s, y las variables independientes fueron sociodemográficas, clínicas y de valoración geriátrica integral. Se calcularon las razones de prevalencia (RP) crudas y ajustadas con intervalos de confianza al 95% (IC95%). Resultados. Se incluyeron 416 adultos mayores, el rango de edad fue de 60 a 99 años y un 41% presentaba velocidad de marcha lenta. Se encontró que los factores asociados a una velocidad de marcha lenta en adultos mayores de la comunidad son el sexo femenino (RP 1,45, IC95%: 1,13-1,88), la edad mayor de 70 años (RP 1,73, IC95%: 1,30-2,30), un menor grado de instrucción (RP. 2.07, IC95%: 1,20-3,55), la presencia de problema socio familiar (RP 1,66, IC95%: 1,08-2,54), la presencia de diabetes mellitus (RP 1,35, IC95%: 1,01-1,80) y de depresión (RP: 1.41, IC95%: 1,02-1,95). Conclusiones. Los factores modificables asociados a una velocidad de marcha lenta en el adulto mayor en la comunidad son tanto clínicos como sociofamiliares, susceptibles de intervención desde etapas precoces en el curso de la vida. Palabras clave: Velocidad de marcha, adulto mayor, comunidad. (Fuente: DeCS BIREME) FACTORS ASSOCIATED WITH SLOW WALKING SPEED IN OLDER ADULTS OF A DISTRICT IN LIMA, PERU ABSTRACTObjectives. To determine the factors associated with slow walking speed in older adults living in a district of Lima, Peru. Materials and methods. Analysis of secondary data. Adults older than 60 years were included in the study, while adults with physical conditions who did not allow the evaluation of the walking speed were excluded. The dependent variable was slow walking speed (less than 1 m/s), and the independent variables were sociodemographic, clinical, and geriatric data. Raw and adjusted prevalence ratios (PR) were calculated with 95% confidence intervals (95% CI). Results. The study sample included 416 older adults aged 60 to 99 years, and 41% of the participants met the slow walking speed criterion. The factors associated with slow walking speed in this sample were female gender (PR, 1.45; 95% CI, 1.13-1.88), age > 70 years (PR, 1.73; 95% CI, 1.30-2.30), lower level of education (PR, 2.07, 95% CI, 1.20-3.55), social-familial problems (PR, 1.66; 95% CI, 1.08-2.54), diabetes mellitus (PR, 1.35; 95% CI, 1.01-1.80), and depression (PR, 1.41; 95% CI, 1.02-1.95). Conclusions. The modifiable factors associated with slow walking speed in older adults included clinical and social-familial problems, and these factors are susceptible to interventions from the early stages of life.

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