Aims Heart failure (HF) is a complex clinical syndrome with multiple comorbidities. Cognitive impairment, stress, anxiety, depression, and lower quality of life are prevalent in HF. Herein, we explore the interplay between these parameters and study their value to predict major adverse cardiovascular events (MACEs) and health-related quality of life (HrQoL) in patients with HF with reduced ejection fraction using guideline recommended assessment tools. Methods and results We conducted a longitudinal study using a sample of 65 patients from two hospitals. A battery of tests was applied to assess cognition [Montreal Cognitive Assessment (MoCA)], stress (Perceived Stress Scale-10), anxiety, and depression (Hospital Anxiety and Depression Scale) at baseline. MACEs were registered using clinical records. HrQoL was estimated using the Kansas City Cardiomyopathy Questionnaire (KCCQ). A descriptive statistical analysis was conducted, and multiple linear and Cox regression models conducted to determine the predictive value of neurocognitive parameters and HrQoL in MACE. Both MoCA [hazard ratio = 0.906 (0.829-0.990); P = 0.029] and KCCQ scores were predictors of MACE, but not of overall mortality. Anxiety, depression, and stress scores did not predict MACE. However, anxiety (β = À0.326; P = 0.012) and depression levels (β = À0.309; P = 0.014) were independent predictors of the KCCQ score. Conclusions The MoCA score and HrQoL were predictors of MACE-free survival. Anxiety and depression were good predictors of HrQoL, but not of MACE-free survival.
Objective To review the evidence about universal iron supplementation in pregnancy to prevent maternal anemia.
Methods Bibliographic research of randomized and controlled clinical trials, meta-analyses, systematic reviews, and clinical guidelines, published between August 2009 and August 2019, using the MeSH terms: iron; therapeutic use; pregnancy; anemia, prevention and control.
Results We included six clinical guidelines, three meta-analyses and one randomized controlled clinical trial.
Discussion Most articles point to the improvement of hematological parameters and reduction of maternal anemia risk, with supplementary iron. However, they do not correlate this improvement in pregnant women without previous anemia with the eventual improvement of clinical parameters.
Conclusion Universal iron supplementation in pregnancy is controversial, so we attribute a SORT C recommendation strength.
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