I Brazilian Registry of Heart Failure - Clinical Aspects, Care Quality and Hospitalization Outcomes

Albuquerque, Denílson Campos de; Neto, João David de Souza; Bacal, Fernando; Rohde, Luis Augusto; Bernardez‐Pereira, Sabrina; Berwanger, Otávio; Almeida, Dirceu Rodrigues

doi:10.5935/abc.20150031

Cited by 122 publications

(194 citation statements)

References 37 publications

(29 reference statements)

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“…Las características del síndrome de ICA pueden tener diferencias regionales significativas (9)(10)(11)(12)(13)(14) , por lo que es importante tomar conocimiento de la realidad local. Nuestro trabajo representa, hasta donde tenemos conocimiento, el primer registro de ICA en Perú y proporciona información inédita sobre esta importante patología cardiovascular.…”

Section: Discussionunclassified

“…Estas frecuencias son similares a lo reportado en registros de Estados Unidos y Europa (15)(16)(17) . Sin embargo, son diferentes a lo reportado en los registros latinoamericanos (9)(10)(11)(12)(13)(14) . Actualmente la enfermedad valvular continúa siendo una causa importante de hospitalización en nuestra imponen un pronóstico sombrío a los pacientes con ICA (3,18) ; en nuestro registro, casi la tercera parte de los pacientes tenían hospitalizaciones previas, con casi un 18% con tres o más hospitalizaciones, y un 23% con más de siete días de estancia hospitalaria.…”

Section: Discussionunclassified

“…Las guías actuales de manejo de ICA recomiendan que los pacientes con ICFEr deben recibir terapia combinada con IECA/BRA, betabloqueadores y un antagonista de aldosterona (5,7) . Sin embargo, pese a la robusta evidencia que demuestra una reducción de mortalidad con esta terapia, su uso en la práctica diaria dista de tener la frecuencia esperada, aun en los países desarrollados (9)(10)(11)(12)(13)20) . Esta realidad se confirma en el presente trabajo, pues se encontraron bajos porcentajes de indicación de las terapias recomendadas por las guías, que se mantienen, incluso, al alta hospitalaria, especialmente en el uso de beta bloqueadores (64,1%) y antagonistas de aldosterona (19,3%), pese al significativo incremento de su uso, producido durante la hospitalización.…”

Section: Fuentes De Financiamiento: Autofinanciadounclassified

“…La mortalidad intrahospitalaria encontrada en nuestra serie es bastante mayor que la reportada en los registros norteamericanos (15,16) y chilenos (9) , aunque considerablemente menor a lo reportado por un registro brasileño y uno internacional de reciente publicación (11,13) ; lo que demuestra la gran variabilidad existente, inclusive entre países de una misma región.…”

Section: Fuentes De Financiamiento: Autofinanciadounclassified

“…En América Latina existe una excesiva carga por ICA que conlleva a altos índices de hospitalización y elevada mortalidad (8) . Registros realizados en Chile, Argentina, Brasil y Colombia, demuestran que existen diferencias importantes, aun en países de una misma región, aunque todos coinciden en la alta mortalidad intrahospitalaria y en la baja prescripción de fármacos basados en evidencia (9)(10)(11)(12) . …”

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Características clínico epidemiológicas de la insuficiencia cardíaca aguda en un hospital terciario de Lima, Perú

Pariona

Saldaña

Reyes

et al. 2017

Rev Peru Med Exp Salud Publica

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Con el objetivo de describir las características clínicas y epidemiológicas de la insuficiencia cardiaca aguda (ICA), se realizó un estudio descriptivo en 1075 pacientes de un hospital de Lima. La edad promedio fue 74 años y el 55% fueron de sexo masculino. El 39% tuvo ICA con fracción de eyección reducida, el 15% con fracción de eyección de rango medio y el 46% con fracción de eyección preservada. Las comorbilidades más frecuentes fueron la hipertensión arterial (52,6%) y la enfermedad coronaria (51%). El 29,2% de los pacientes tuvo hospitalizaciones previas por ICA. La mediana de la estancia hospitalaria fue de 3 días. La mortalidad intrahospitalaria por todas las causas fue 7,2%. La hospitalización ocurre, predominantemente, en pacientes de edad avanzada y con múltiples comorbilidades. El bajo uso de fármacos recomendados, conjuntamente con la alta frecuencia de hospitalizaciones previas, probablemente, inciden en la alta tasa de mortalidad registrada en el presente estudio.Palabras clave : Insuficiencia cardíaca, hospitalización, mortalidad intrahospitalaria, epidemiologia, Perú (fuente: DeCS BIREME) EPIDEMIOLOGICAL CLINICAL CHARACTERISTICS OF ACUTE CARDIAC INSUFFICIENCY IN A TERTIARY HOSPITAL IN LIMA, PERU ABSTRACTThe objective of this study was to describe the clinical and epidemiological characteristics of acute heart failure (AHF) in 1,075 patients from a hospital in Lima, Peru. The average patient age was 74 years and 55% of study subjects were men. Moreover, 39% of patients in the sample had AHF with low ejection fraction, 15% had intermediate ejection fraction, and 46% had preserved ejection fraction. The most common comorbidities were hypertension (52.6%) and coronary disease (51%). Moreover, 29.2% of patients had previous hospitalizations due to AHF. The median hospital stay was 3 days. The rate of inhospital mortality from all causes was 7.2%. Hospitalization was more common in elderly patients with multiple comorbidities. The low use of prescription drugs together with the high rate of previous hospitalizations may explain the high mortality rate reported in this study. INTRODUCCIÓNSe estima que aproximadamente un millón de hospitalizaciones por insuficiencia cardíaca aguda (ICA) se producen anualmente en los Estados Unidos y se espera que este número se eleve significativamente durante las próximas décadas (1)(2) . La ICA se ha convertido en la principal causa de hospitalización en personas mayores de 65 años, con altas tasas de mortalidad y reingresos frecuentes (3) . Es importante señalar que el costo del tratamiento por ICA está representado, principalmente, por el costo de las hospitalizaciones (4) . Aunque no existe una definición y/o nomenclatura universalmente aceptada para los "síndromes de insuficiencia cardíaca" que requieren hospitalización, probablemente la más aceptada es la preconizada por la Sociedad Europea de Cardiología: «Condición médica que amenaza la vida, que requiere típicamente hospitalización, caracterizada por un inicio rápido o empeoramiento de síntomas y/o signos ...

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Características clínico epidemiológicas de la insuficiencia cardíaca aguda en un hospital terciario de Lima, Perú

Pariona

Saldaña

Reyes

et al. 2017

Rev Peru Med Exp Salud Publica

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Multifaceted Strategy Based on Automated Text Messaging After a Recent Heart Failure Admission

Rohde,

Rover,

Hoffmann Filho

et al. 2024

JAMA Cardiol

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ImportanceReadmissions after an index heart failure (HF) hospitalization are a major contemporary health care problem.ObjectiveTo evaluate the feasibility and efficacy of an intensive telemonitoring strategy in the vulnerable period after an HF hospitalization.Design, Setting, and ParticipantsThis randomized clinical trial was conducted in 30 HF clinics in Brazil. Patients with left ventricular ejection fraction less than 40% and access to mobile phones were enrolled up to 30 days after an HF admission. Data were collected from July 2019 to July 2022.InterventionParticipants were randomly assigned to a telemonitoring strategy or standard care. The telemonitoring group received 4 daily short message service text messages to optimize self-care, active engagement, and early intervention. Red flags based on feedback messages triggered automatic diuretic adjustment and/or a telephone call from the health care team.Main Outcomes and MeasuresThe primary end point was change in N-terminal pro–brain natriuretic peptide (NT-proBNP) from baseline to 180 days. A hierarchical win-ratio analysis incorporating blindly adjudicated clinical events (cardiovascular deaths and HF hospitalization) and variation in NT-proBNP was also performed.ResultsOf 699 included patients, 460 (65.8%) were male, and the mean (SD) age was 61.2 (14.5) years. A total of 352 patients were randomly assigned to the telemonitoring strategy and 347 to standard care. Satisfaction with the telemonitoring strategy was excellent (net promoting score at 180 days, 78.5). HF self-care increased significantly in the telemonitoring group compared with the standard care group (score difference at 30 days, −2.21; 95% CI, −3.67 to −0.74; P = .001; score difference at 180 days, −2.08; 95% CI, −3.59 to −0.57; P = .004). Variation of NT-proBNP was similar in the telemonitoring group compared with the standard care group (telemonitoring: baseline, 2593 pg/mL; 95% CI, 2314-2923; 180 days, 1313 pg/mL; 95% CI, 1117-1543; standard care: baseline, 2396 pg/mL; 95% CI, 2122-2721; 180 days, 1319 pg/mL; 95% CI, 1114-1564; ratio of change, 0.92; 95% CI, 0.77-1.11; P = .39). Hierarchical analysis of the composite outcome demonstrated a similar number of wins in both groups (telemonitoring, 49 883 of 122 144 comparisons [40.8%]; standard care, 48 034 of 122 144 comparisons [39.3%]; win ratio, 1.04; 95% CI, 0.86-1.26).Conclusions and RelevanceAn intensive telemonitoring strategy applied in the vulnerable period after an HF admission was feasible, well-accepted, and increased scores of HF self-care but did not translate to reductions in NT-proBNP levels nor improvement in a composite hierarchical clinical outcome.Trial RegistrationClinicalTrials.gov Identifier: NCT04062461

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Exhaled breath acetone for predicting cardiac and overall mortality in chronic heart failure patients

et al. 2020

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Aims Exhaled breath acetone (EBA) has been described as a new biomarker of heart failure (HF) diagnosis. EBA concentration increases according to severity of HF and is associated with poor prognosis, especially in acute decompensated HF. However, there are no data on chronic HF patients. The aim is to evaluate the role of EBA for predicting cardiac and overall mortality in chronic HF patients. Methods and results In GENIUS-HF cohort, chronic patients were enrolled between August 2012 and December 2014. All patients had left ventricular ejection fraction ≤ 50%, and the diagnosis was established according to Framingham criteria. After consent, patients were submitted to clinical evaluation and exhaled breath collection. EBA identification and quantitative determination were done by spectrophotometry. The clinical characteristics associated with acetone were identified. All participants were followed for 18 months to assess cardiac and overall mortality. Around 700 participants were enrolled in the current analysis. Patients were 55.4 ± 12.2 years old, 67.6% male patients, and 81% New York Heart Association I/II with left ventricular ejection fraction of 32 ± 8.6%. EBA median concentration was 0.6 (0.3-1.2) ug/L. Acetone levels increased with the number of symptoms of HF and were associated with right HF signs/symptoms and liver biochemical changes. EBA at highest quartile (EBA > 1.2ug/L) was associated with a significantly worse prognosis (log rank test, P < 0.001). Cox proportional multivariable regression model revealed that EBA > 1.20ug/L was an independent predictor of cardiac (P = 0.011) and overall (P = 0.010) mortality in our population. Conclusions This study shows that EBA levels reflect clinical HF features, especially right HF signs/symptoms. EBA is an independent predictor of cardiac and overall mortality in chronic HF patients.

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I Brazilian Registry of Heart Failure - Clinical Aspects, Care Quality and Hospitalization Outcomes

Cited by 122 publications

References 37 publications

Características clínico epidemiológicas de la insuficiencia cardíaca aguda en un hospital terciario de Lima, Perú

Características clínico epidemiológicas de la insuficiencia cardíaca aguda en un hospital terciario de Lima, Perú

Multifaceted Strategy Based on Automated Text Messaging After a Recent Heart Failure Admission

Exhaled breath acetone for predicting cardiac and overall mortality in chronic heart failure patients

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