Safety of SGLT2 inhibitors in very elderly diabetic type 2 patients in real life

Introduction: Sodium glucose cotransporter 2 inhibitors (SGLT2i) are the latest antidiabetic treatments that reduces mortality and cardiovascular outcomes. Its use in real life in very elderly patients is limited by its possible side effects. Material and methods: We conducted a retrospective study of patients treated with SGLT2i in our community (La Rioja) since 2014. The safety (adverse effects) and prognosis (mortality, cardiac decompensation, and cardiovascular events) during the first 24 months of treatment were evaluated. Results: We included 235 patients treated with SGLT2i, 114 of them were men (48.5%), and the mean age was 79.6 ± 3.9 years. The most used SGLT2i was empagliflozin (55.7%). The mean Hb1Ac at the time of inclusion was 7.9 ± 1.4, showing a decrease in 47.7% of the included patients during the follow up. The initial values of creatinine and glomerular filtration rate at the time of inclusion (0.94 ± 0.3 and 68.3 ± 16.4) presented an improvement at 24 months of treatment (0.94 ± 0.27 and 68.2 ± 15.8). During follow-up, 94 adverse events were described in 84 patients, and 53 treatment suspensions. This adverse events were related with sex (p 0.004), dapagliflozin (p < 0.001) and initial Hb1Ac values (p 0.04). The most common adverse event were genitourinary infections (63), followed by acute kidney injury (9), being the latter the most frequent cause of treatment interruption. Symptomatic hypoglycaemia during the follow-up was related with treatment of insulin, age and Hb1Ac (p <0.01). Conclusions: Treatment with SGLT2i is a safe and well-tolerated treatment in very elderly patients in real life. Genitourinary infections are the most common adverse events, but those that less frequently cause treatment interruption

Relationship between nutritional status and length of hospital stay among patients with atrial fibrillation – a result of the nutritional status heart study

BackgroundNutritional status is related to the prognosis and length of hospital stay (LOHS) of patients with atrial fibrillation (AF). This study aimed to assess how nutritional status affects LOHS for patients with AF.MethodsWe performed retrospective analysis of the medical records of 1,813 patients admitted urgently with a diagnosis of AF to the Institute of Heart Diseases of the University Clinical Hospital in Wroclaw, Poland.ResultsIn total, 1,813 patients were included in the analysis. The average LOHS in the entire group was 3.53 ± 3.41 days. The mean BMI was 28.7 kg/m2 (SD: 5.02). Patients who were hospitalized longer were statistically more likely to have a Nutritional Risk Score (NRS) ≥3 (p = 0.028). A higher percentage of longer hospitalized patients with LDL levels below 70 mg/dl (p &lt; 0.001) and those with HDL ≥40 mg/dl (p &lt; 0.001) were observed. Study participants with NRS ≥3 were an older group (M = 76.3 years), with longer mean LOHS (M = 4.44 days). The predictors of LOHS in the univariate model were age (OR = 1.04), LDL (OR = 0.99), HDL (OR = 0.98), TC (OR = 0.996), CRP (OR = 1, 02, p &lt; 0.001), lymphocytes (OR = 0.97, p = 0.008) and in the multivariate model were age, LDL (mg/dl), HDL (mg/dl), Na, and K.ConclusionFor nutritional status, factors indicating the risk of prolonged hospitalization in patients with AF are malnutrition, lower serum LDL, HDL, potassium, and sodium levels identified at the time of admission to the cardiology department. Assessment of nutritional status in patients with AF is important both in the context of evaluating obesity and malnutrition status, as both conditions can alter the prognosis of patients. Further studies are needed to determine the exact impact of the above on the risk of prolonged hospitalization

Evaluación del impacto de la bendopnea en la insuficiencia cardiaca descompensada

Objetivos: Evaluar las características y el valor pronóstico de la bendopnea a los 6-12 meses tras el ingreso de pacientes con insuficiencia cardiaca (IC) descompensada. Material y métodos: Estudio de cohortes prospectivo. Se incluyeron a pacientes ingresados en el Servicio de Medicina Interna con diagnóstico de IC descompensada. Se consideró a la presencia de bendopnea a la falta de aire producida dentro de los primeros 30 segundos durante la flexión anterior del tronco. Resultados: Se obtuvieron 250 pacientes de los cuales 122 (48,8%) presentaban bendopnea al ingreso. La edad media fue de 81,8 años (± 8,3), 128 eran hombres (51,2%), 143 (57,2%) con clase funcional avanzada (NYHA III/IV). El tiempo medio de aparición fue de 13,4 segundos (± 6,9). La mortalidad a los 6 meses fue del 23,2% y la tasa de reingresos del 56,8%. Los pacientes con bendopnea presentaron una mayor frecuencia de ortopnea, disnea paroxística nocturna, oliguria, edema, presión venosa yugular elevada, plenitud abdominal y peor clase funcional (P <0.001). La dilatación de ambas aurículas fue másfrecuente en estos pacientes (p < 0,001) así como el aumento de la PSAP (p = 0,001). La limitación de la calidad de vida secundaria estuvo presente en 80.3% de los pacientes. La presencia de bendopnea mostró asociación con la mortalidad a un año (p = 0,04) y a los 6 meses (p = 0,025). Conclusión: La presencia de bendopnea está relacionada con otros síntomas de IC, clase funcional avanzada y aumento de mortalidad a corto plazo (6-12 meses)

Relationship between nutritional status and length of hospital stay among patients with atrial fibrillation – a result of the nutritional status heart study

BACKGROUND: Nutritional status is related to the prognosis and length of hospital stay (LOHS) of patients with atrial fibrillation (AF). This study aimed to assess how nutritional status affects LOHS for patients with AF. METHODS: We performed retrospective analysis of the medical records of 1,813 patients admitted urgently with a diagnosis of AF to the Institute of Heart Diseases of the University Clinical Hospital in Wroclaw, Poland. RESULTS: In total, 1,813 patients were included in the analysis. The average LOHS in the entire group was 3.53 ± 3.41 days. The mean BMI was 28.7 kg/m(2) (SD: 5.02). Patients who were hospitalized longer were statistically more likely to have a Nutritional Risk Score (NRS) ≥3 (p = 0.028). A higher percentage of longer hospitalized patients with LDL levels below 70 mg/dl (p < 0.001) and those with HDL ≥40 mg/dl (p < 0.001) were observed. Study participants with NRS ≥3 were an older group (M = 76.3 years), with longer mean LOHS (M = 4.44 days). The predictors of LOHS in the univariate model were age (OR = 1.04), LDL (OR = 0.99), HDL (OR = 0.98), TC (OR = 0.996), CRP (OR = 1, 02, p < 0.001), lymphocytes (OR = 0.97, p = 0.008) and in the multivariate model were age, LDL (mg/dl), HDL (mg/dl), Na, and K. CONCLUSION: For nutritional status, factors indicating the risk of prolonged hospitalization in patients with AF are malnutrition, lower serum LDL, HDL, potassium, and sodium levels identified at the time of admission to the cardiology department. Assessment of nutritional status in patients with AF is important both in the context of evaluating obesity and malnutrition status, as both conditions can alter the prognosis of patients. Further studies are needed to determine the exact impact of the above on the risk of prolonged hospitalization

Estándares de la Sociedad Española de Arteriosclerosis 2024 para el control global del riesgo vascular

La Sociedad Española de Arteriosclerosis (SEA) tiene entre sus objetivos contribuir al conocimiento, prevención y tratamiento de las enfermedades vasculares, que son la primera causa de muerte en España y conllevan un elevado grado de discapacidad y gasto sanitario. La arteriosclerosis es una enfermedad multifactorial y su prevención exige un abordaje global que contemple los factores de riesgo asociados. Este documento resume la evidencia actual e incluye recomendaciones a seguir ante el paciente con enfermedad vascular establecida o con un elevado riesgo vascular (RV): se revisan los síntomas y signos a evaluar, los procedimientos de laboratorio e imagen a solicitar rutinariamente o en situaciones especiales, e incluye la estimación del RV, criterios diagnósticos de las entidades que son factores de riesgo vascular (FRV), y plantea recomendaciones generales y específicas para su tratamiento. Por último, se presentan aspectos poco referenciados en la literatura, como son, por ejemplo, la organización de una consulta de RV

Estándares SEA 2022 para el control global del riesgo cardiovascular

One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to better knowledge of vascular disease, its prevention and treatment. It is well known that cardiovascular diseases are the leading cause of death in our country and entail a high degree of disability and health care costs. Arteriosclerosis is a multifactorial disease and therefore its prevention requires a global approach that takes into account the different risk factors with which it is associated. Therefore, this document summarizes the current level of knowledge and includes recommendations and procedures to be followed in patients with established cardiovascular disease or at high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or requested for those in special situations. It also includes vascular risk estimation, the diagnostic criteria of the different entities that are cardiovascular risk factors, and makes general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not usually referenced in the literature, such as the organization of a vascular risk consultation. (c) 2021 The Authors. Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Arteriosclerosis. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/)