Prevalence, Incidence, and Outcomes of Hyperkalaemia in Patients with Chronic Heart Failure and Reduced Ejection Fraction from a Spanish Multicentre Study: SPANIK-HF Design and Baseline Characteristics

[Abstract] Hyperkalaemia is a growing concern in the treatment of patients with heart failure and reduced ejection fraction (HFrEF) as it limits the use of some prognostic-modifying drugs and has a negative impact on prognosis. The objective of the present study was to estimate the prevalence of hyperkalaemia in outpatients with HFrEF and its impact on achieving optimal medical treatment. For this purpose, a multicentre, prospective, and observational study was carried out on consecutive HFrEF patients who were monitored as outpatients in heart failure (HF) units and who, in the opinion of their doctor, received optimal medical treatment. A total of 565 HFrEF patients were included from 16 specialised HF units. The mean age was 66 ± 12 years, 78% were male, 45% had an ischemic cause, 39% had atrial fibrillation, 43% were diabetic, 42% had a glomerular filtration rate < 60 mL/min/1.7 m2, and the mean left ventricular ejection fraction was 31 ± 7%. Treatment at the study entry included: 76% on diuretics, 13% on ivabradine, 7% on digoxin, 18.9% on angiotensin-conversing enzyme inhibitors (ACEi), 11.3% on angiotensin receptors blockers (ARBs), 63.8% on angiotensin-neprilysin inhibitors (ARNi), 78.5% on mineralocorticoid receptor antagonists (MRAs), and 92.9% on beta-blockers. Potassium levels in the baseline analysis were: ≤5 mEq/L = 80.5%, 5.1–5.4 mEq/L = 13.8%, 5.5–5.9 mEq/L = 4.6%, and ≥6 mEq/L = 1.06%. Hyperkalaemia was the reason for not prescribing or reaching the target dose of an MRAs in 34.8% and 12.5% of patients, respectively. The impact of hyperkalaemia on not prescribing or dropping below the target dose in relation to ACEi, ARBs, and ARNi was significantly less. In conclusion, hyperkalaemia is a frequent problem in the management of patients with HFrEF and a limiting factor in the optimisation of medical treatment.AstraZeneca Farmacéutica; ESR-17-1324

Clinical Utility of HeartLogic, a Multiparametric Telemonitoring System, in Heart Failure

Telemonitoring through multiple variables measured on cardiac devices has the potential to improve the follow-up of patients with heart failure. The HeartLogic algorithm (Boston Scientific), implemented in some implantable cardiac defibrillators and cardiac resynchronisation therapy, allows monitoring of the nocturnal heart rate, respiratory movements, thoracic impedance, physical activity and the intensity of heart tones, with the aim of predicting major clinical events. Although HeartLogic has demonstrated high sensitivity for the detection of heart failure decompensations, its effects on hospitalisation and mortality in randomised clinical trials has not yet been corroborated. This review details how the HeartLogic algorithm works, compiles available evidence from clinical studies, and discusses its application in daily clinical practice

Hyperkalemia in Heart Failure Patients in Spain and Its Impact on Guidelines and Recommendations: ESC-EORP-HFA Heart Failure Long-Term Registry

[Abstract] Introduction and objectives: Hyperkalemia is a growing concern in the treatment of patients with heart failure and reduced ejection fraction because it limits the use of effective drugs. We report estimates of the magnitude of this problem in routine clinical practice in Spain, as well as changes in potassium levels during follow-up and associated factors. Methods: This study included patients with acute (n=881) or chronic (n=3587) heart failure recruited in 28 Spanish hospitals of the European heart failure registry of the European Society of Cardiology and followed up for 1 year. Various outcomes were analyzed, including changes in serum potassium levels and their impact on treatment. Results: Hyperkalemia (K+> 5.4 mEq/L) was identified in 4.3% (95%CI, 3.7%-5.0%) and 8.2% (6.5%-10.2%) of patients with chronic and acute heart failure, respectively, and was responsible for 28.9% of all cases of contraindication to mineralocorticoid receptor antagonist use and for 10.8% of all cases of failure to reach the target dose. Serum potassium levels were not recorded in 291 (10.8%) of the 2693 chronic heart failure patients with reduced ejection fraction. During follow-up, potassium levels increased in 179 of 1431 patients (12.5%, 95%CI, 10.8%-14.3%). This increase was directly related to age, diabetes, and history of stroke and was inversely related to history of hyperkalemia. Conclusions: This study highlights the magnitude of the problem of hyperkalemia in patients with heart failure in everyday clinical practice and the need to improve monitoring of this factor in these patients due to its interference with the possibility of receiving optimal treatment.[Resumen] Introducción y objetivos. La hiperpotasemia es una preocupación creciente en el tratamiento de los pacientes con insuficiencia cardiaca y fracción de eyección reducida, pues limita el uso de fármacos eficaces. Este trabajo ofrece estimaciones de la magnitud de este problema en la práctica clínica habitual en España, los cambios en las concentraciones de potasio en el seguimiento y los factores asociados. Métodos. Pacientes con insuficiencia cardiaca aguda (n = 881) y crónica (n = 3.587) seleccionados en 28 hospitales españoles del registro europeo de insuficiencia cardiaca de la European Society of Cardiology y seguidos 1 año para diferentes desenlaces, incluidos cambios en las cifras de potasio y su impacto en el tratamiento. Resultados. La hiperpotasemia (K+ > 5,4 mEq/l) está presente en el 4,3% (IC95%, 3,7-5,0%) y el 8,2% (6,5-10,2%) de los pacientes con insuficiencia cardiaca crónica y aguda; causa el 28,9% de todos los casos en que se contraindica el uso de antagonistas del receptor de mineralocorticoides y el 10,8% de los que no alcanzan la dosis objetivo. Del total de 2.693 pacientes ambulatorios con fracción de eyección reducida, 291 (10,8%) no tenían registrada medición de potasio. Durante el seguimiento, 179 de 1.431 (12,5%, IC95%, 10,8-14,3%) aumentaron su concentración de potasio, aumento relacionado directamente con la edad, la diabetes mellitus y los antecedentes de ictus e inversamente con los antecedentes de hiperpotasemia. Conclusiones. Este trabajo destaca el problema de la hiperpotasemia en pacientes con insuficiencia cardiaca de la práctica clínica habitual y la necesidad de continuar y mejorar la vigilancia de este factor en estos pacientes por su interferencia en el tratamiento óptimo

Descompensaciones en insuficiencia cardiaca, una realidad más amplia

Sin financiación24.4 Q1 JCR 20228.343 Q1 SJR 2022No data IDR 2022UE

Personalized Therapy and Clinical Outcome for Heart Failure

Sin financiación3.9 Q2 JCR 20220.935 Q1 SJR 2022No data IDR 2022UE

Impact of early follow-up from primary care on 30 days readmission after heart failure hospitalization

Introducción Reducir ingresos por insuficiencia cardiaca (IC) es uno de los principales objetivos en el control de la enfermedad, por su impacto en el pronóstico y en el gasto sanitario. Los modelos transicionales al alta se imponen como una estrategia capaz de reducirlos, la mayoría basados en unidades hospitalarias específicas. Tratamos de valorar el impacto del seguimiento post-alta realizado desde atención primaria (AP). Material y métodos Estudio ecológico observacional retrospectivo en el área de referencia de un hospital terciario. Se efectúa un análisis de regresión lineal entre la tasa de seguimiento precoz desde el centro de salud tras un ingreso por IC y las tasas de reingreso a 30 días por todas las causas a lo largo de 2021. Resultados El grado de seguimiento desde AP tras un alta hospitalaria por insuficiencia cardiaca se asocia con un menor reingreso a 30 días por todas las causas (R de Pearson = 0,53; p = 0,02), con un descenso del 20%, similar al observado cuando se realiza desde otros dispositivos asistenciales y que se mantiene cuando se ajusta por complejidad de los pacientes. Conclusiones Tras un ingreso por IC, el seguimiento post-alta desde AP puede ser eficaz, reduciendo ingresos evitables y complementario al realizado por las unidades hospitalarias.Introduction Reducing heart failure (HF) admissions is one of the main objectives in disease control, due to its impact on prognosis and costs. The transitional models at discharge are imposed as a strategy capable of reducing hospitalizations, most of them based on specific hospital units. We analyzed the impact of the primary care (PC) post-discharge follow-up. Material and methods Retrospective observational study at the referral area of a tertiary hospital. Linear regression analysis was performed between early follow-up from the PC center after HF admission rate and the 30-day all-cause readmission rate throughout 2021. Results The degree of follow-up from PC after hospital discharge for heart failure is associated with fewer 30-day readmissions for all causes (Pearson's R = 0.53, P = .02); with a decrease of 20%, similar to that observed when it is performed from other care facilities and which is maintained when adjusting for the complexity of the patients. Conclusions PC heart failure post-discharge follow-up could be effective in reducing hospitalizations, and is complementary to that carried out by hospital units.Sin financiación1.1 Q4 JCR 20220.193 Q3 SJR 2022No data IDR 2022UE

Selection of the best of 2022 in heart failure

Durante este último año se han publicado múltiples estudios de máximo interés en el campo de la insuficiencia cardiaca. Hemos realizado una revisión sistemática de las publicaciones más relevantes, desde el 5 de septiembre de 2021 hasta la misma fecha de 2022, seleccionando aquellas publicaciones más destacadas y ordenándolas por bloques temáticos. Se incluyen referencias a la guía norteamericana sobre insuficiencia cardiaca y a las guías conjuntas de las sociedades europeas de cardiología y respiratorio en hipertensión pulmonar, ambas publicadas en este periodo.Multiple studies of maximum interest have been published in the field of heart failure during the last year. We have carried out a systematic review of the most relevant publications (from 05-09-2021 to 05-09-2022), selecting the most outstanding publications, ordering them by thematic blocks. References to the American guidelines on heart failure and the joint guidelines of the European societies of cardiology and respiration in pulmonary hypertension, both published in this period, are included.Sin financiaciónNo data JCR 20220.138 Q4 SJR 2022No data IDR 2022UE

Baroreflex activation therapy in patients with heart failure and reduced ejection fraction

Sin financiación5.9 Q1 JCR 20220.463 Q3 SJR 2022No data IDR 2022UE

De Novo Donor-Specific Antibodies after Heart Transplantation: A Comprehensive Guide for Clinicians

Antibodies directed against donor-specific human leukocyte antigens (HLAs) can be detected de novo after heart transplantation and play a key role in long-term survival. De novo donor-specific antibodies (dnDSAs) have been associated with cardiac allograft vasculopathy, antibody-mediated rejection, and mortality. Advances in detection methods and international guideline recommendations have encouraged the adoption of screening protocols among heart transplant units. However, there is still a lack of consensus about the correct course of action after dnDSA detection. Treatment is usually started when antibody-mediated rejection is present; however, some dnDSAs appear years before graft failure is detected, and at this point, damage may be irreversible. In particular, class II, anti-HLA-DQ, complement binding, and persistent dnDSAs have been associated with worse outcomes. Growing evidence points towards a more aggressive management of dnDSA. For that purpose, better diagnostic tools are needed in order to identify subclinical graft injury. Cardiac magnetic resonance, strain techniques, or coronary physiology parameters could provide valuable information to identify patients at risk. Treatment of dnDSA usually involves plasmapheresis, intravenous immunoglobulin, immunoadsorption, and ritxumab, but the benefit of these therapies is still controversial. Future efforts should focus on establishing effective treatment protocols in order to improve long-term survival of heart transplant recipients