Heart failure in COVID-19 patients: prevalence, incidence and prognostic implications

Aims: Data on the impact of COVID-19 in chronic heart failure (CHF) patients and its potential to trigger acute heart failure (AHF) are lacking. The aim of this work was to study characteristics, cardiovascular outcomes and mortality in patients with confirmed COVID-19 infection and a prior diagnosis of heart failure (HF). Further aims included the identification of predictors and prognostic implications for AHF decompensation during hospital admission and the determination of a potential correlation between the withdrawal of HF guideline-directed medical therapy (GDMT) and worse outcomes during hospitalization. Methods and results: Data for a total of 3080 consecutive patients with confirmed COVID-19 infection and follow-up of at least 30 days were analysed. Patients with a previous history of CHF (n = 152, 4.9%) were more prone to the development of AHF (11.2% vs. 2.1%; P < 0.001) and had higher levels of N-terminal pro brain natriuretic peptide. In addition, patients with previous CHF had higher mortality rates (48.7% vs. 19.0%; P < 0.001). In contrast, 77 patients (2.5%) were diagnosed with AHF, which in the vast majority of cases (77.9%) developed in patients without a history of HF. Arrhythmias during hospital admission and CHF were the main predictors of AHF. Patients developing AHF had significantly higher mortality (46.8% vs. 19.7%; P < 0.001). Finally, the withdrawal of beta-blockers, mineralocorticoid receptor antagonists and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a significant increase in in-hospital mortality. Conclusions: Patients with COVID-19 have a significant incidence of AHF, which is associated with very high mortality rates. Moreover, patients with a history of CHF are prone to developing acute decompensation after a COVID-19 diagnosis. The withdrawal of GDMT was associated with higher mortalit

Direct antiviral agents : efficiency and security in the treatment of the hepatitis for C virus

Actualmente, el tratamiento del virus de la hepatitis C (VHC) está sufriendo una auténtica revolución. Con la reciente disponibilidad de los agentes antivirales directos (AADs) de segunda generación se están consiguiendo tasas de curación superiores al 90%, incluso con terapias libres de interferón pegilado y ribavirina. En este trabajo, en primer lugar, se realiza un repaso general del VHC, enfatizando, sobre todo, en las distintas posibilidades terapéuticas que existen con los fármacos de reciente aparición. Por otra parte, consta de un trabajo de investigación, sobre una cohorte de 71 pacientes trasplantados hepáticos, con recidiva del VHC. Las conclusiones principales a las que hemos llegado son, por un lado, que las terapias con agentes antivirales directos, libres de interferón, son altamente eficaces; independientemente del tipo de recidiva (clásica o colestática fibrosante), grado de fibrosis hepática, edad o tratamiento previo contra el VHC recibido. Por otra parte, muy interesante es el descenso de los niveles de inmunosupresores que se origina a raíz de erradicar el virus, probablemente debido a la mejora del aclaramiento hepático; que implica tener especial cuidado en el manejo de estos pacientes, para evitar el rechazo del órgano.Currently, the treatment of Hepatitis C virus (HCV) is undergoing a revolution. With the recent availability of second-generation direct antiviral agents (DAAs) cure rates higher than 90% are being achieved, even with pegylated interferon free therapy and ribavirin. In this research, first, an overview of HCV is carried out, emphasizing, above all, in the different therapeutic possibilities that exist in emerging drugs. On the other hand, it consists of a research on a cohort study of 71 liver transplant patients with relapsed HCV. The main conclusions we have reached are, firstly, that therapies with direct antiviral agents, interferon-free, are highly efficient; regardless of the type of recurrence (classical or fibrosing cholestatic), degree of hepatic fibrosis, age or prior HCV treatment received. Also, it is very interesting the decrease in the levels of immunosuppressors when virus is cleared, probably due to improving hepatic function; which means taking special care in handling these patients to prevent organ rejection.Grado en Medicin