Evaluación de la función renal en pacientes con insuficiencia cardiaca descompensada en servicios de medicina interna

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 04-04-201

Prognostic significance of the PROFUND index on one year mortality in acute heart failure: results from the RICA registry

Background: Heart failure (HF) is a syndrome with high prevalence, mainly affecting elderly patients, where the presence of associated comorbidities is of great importance. Methods: An observational study from a prospective registry was conducted. Patients identified from the National Registry of Heart Failure (RICA), which belongs to theWorking Group on Heart Failure and Atrial Fibrillation of the Spanish Society of Internal Medicine (SEMI), were included. The latter is a prospective, multicenter registry that has been active since 2008. It includes individual consecutive patients over 50 years of age with a diagnosis of HF at hospital discharge (acute decompensated or new-onset HF). Results: In total, 5424 patients were identified from the registry. Forty-seven percent were men and mean left ventricular ejection fraction (LVEF) was 51.4%; 1132 had a score of 0 to 2 according to the PROFUND index, 3087 had a score of 3 to 6, and 952 patients had a score of 7 to 10 points. In the sample, 252 patients had a score above 11 points. At the end of the year of follow-up, 61% of the patients died. This mortality increased proportionally as the PROFUND index increased, specifically 75% for patients with PROFUND greater than 11. The Kaplan-Meier survival curve shows that survival at one year progressively decreases as the PROFUND index value increases. Thus, subjects with scores greater than seven (intermediate-high and high-risk) presented the worst survival with a log rank of 0.96 and a p < 0.05. In the regression analysis, we found a higher risk of death from any cause at one year in the group with the highest risk according to the PROFUND index (score greater than 11 points (HR 1.838 (1.410-2.396)). Conclusions: The PROFUND index is a good index for predicting mortality in patients admitted for acute HF, especially in those subjects at intermediate to high risk with scores above seven. Future studies should seek to determine whether the PROFUND index score is simply a prognostic marker or whether it can also be used to make therapeutic decisions for those subjects with very high short-term mortality

Preconfigured analytical profiles for the management of patients with heart failure: a consensus-driven study

The standardized use of laboratory blood tests will promote effective resource utilization, minimize waste, and improve healthcare services. The objective of this work is to develop a set of parameters that constitute essential preconfigured analytical profiles (PAPs) for the clinical management of patients with heart failure. A consensus-driven process was performed among a multidisciplinary team of 7 Spanish healthcare professionals working in hospitals located in different Spanish regions. A total of 6 PAPs were identified, aiming for different objectives: identifying the cause of heart failure (“de novo PAP”); monitoring the patient at various times and scenarios (“Outpatient follow-up PAP,” “Hospital admission PAP,” “Hospital evolution PAP,” “Titration and decompensation control PAP”); and titrating medication (“Drug titration PAP,” “Titration and decompensation control PAP”). The use and implementation of these PAPs by healthcare professionals should facilitate the standardization of patient care and potentially improve clinical outcomes and healthcare resource utilization. El uso de análisis de laboratorio estandarizados podría mejorar la atención médica y la utilización de recursos sanitarios. El objetivo de este trabajo es desarrollar un listado de parámetros denominados perfiles analíticos preconfigurados (PAP) para el abordaje clínico de pacientes con insuficiencia cardiaca. Se llevó a cabo un proceso de consenso por un equipo multidisciplinar de 7 profesionales sanitarios pertenecientes a hospitales de diferentes regiones españolas. Se identificó un total de 6 PAP, con diferentes objetivos: identificación de la causa de la insuficiencia cardiaca («de novo PAP»); monitorización («PAP de seguimiento ambulatorio», «PAP de admisión hospitalaria», «PAP de evolución hospitalaria», «PAP de titulación y control de descompensación»); y titulación («PAP de titulación de medicamentos», «PAP de titulación y control de descompensación»). El uso e implementación de estos PAP en el sistema sanitario debería facilitar la estandarización del cuidado del paciente, mejorar los resultados clínicos y la utilización de recursos