Antithrombotic Therapy in Elderly Patients with Acute Coronary Syndromes

The treatment of acute coronary syndrome (ACS) in elderly patients continues to be a challenge because of the characteS.G.B.ristics of this population and the lack of data and specific recommendations. This review summarizes the current evidence about critical points of oral antithrombotic therapy in elderly patients. To this end, we discuss the peculiarities and differences reported referring to dual antiplatelet therapy (DAPT) in ACS management in elderly patients and what might be the best option considering these population characteristics. Furthermore, we analyze antithrombotic strategies in patients with atrial fibrillation (AF), with a particular focus on those cases that also present coronary artery disease (CAD). It is imperative to deepen our knowledge regarding the management of these challenging patients through real-world data and specifically designed geriatric studies to help resolve the questions remaining in their disease management

Caracterización y seguimiento de una población no seleccionada de pacientes ingresados por insuficiencia cardíaca en un hospital terciario

Se describen las características de los ingresos por insuficiencia cardíaca IC en el Hospital Gregorio Marañón en 1996 y su relación con el pronóstico. Se comparan los datos con el censo realizado en Madrid ese año. Conclusiones: 1,- Edad media alta 74,8 años, mujeres 58%, frecuentemente patología concomitante múltiple, estancia media prolongada 16 días reingresos frecuentes y mortalidad intrahospitalaria elevada 8,3%. 2,- 23% de los pacientes diagnosticado de IC sin presentar datos de IC al ingreso. 3,- Prevalencia anual de ingresos/1000 habitantes: 2,1, aumentó con edad siendo 34 en mayores de 80 años. 4,- Variaciones estacionales en hospitalizaciones, entre 25% por encima de la media en enero a 33% por debajo en Agosto. 5,- El riesgo de disfunción sistólica se incrementa con: infarto de miocardio previo, bloqueo de rama izquierda, tabaquismo y sexo masculino. Edad, cirugía valvular previa y fibrilación auricular se asociaron con menos disfunción. 6,- La mortalidad intrahospitalaria aumenta con la disfunción (codificada de no = 0 a severa = 3; OR 1,6), estenosis valvular (igual codificación; OR, 1,6 mitral y 1,8 aótica) y accidente crebrovascular previo (OR 3,1). Ingresar en cardiología es factor protector (OR 0,4). 7,- Uso de IECAs bajo 53%, más alto y mayor dosis en Caradiología. La tasa de prescripción en pacientes con disfunción ventricular disminuye con insuficiencia renal y estenosis aórtica, aumentando con grados más severos de disfunción. 8,- Supervivencia baja, a los 6 meses 82,1%, al año 74,7%, a los 2 años 61,9%, a los 3 años 47,7%. Variables predictoras de mortalidad en seguimiento: edad, (OR: 1,03), accidente cerebrobascular previo e insuficiencia renal (cada una duplica riesgo), disfunción ventricular y estenosis aórtica, con OR, 1,1 y 1,3 respectivamente (codificadas de no=0 a severa=3

Ischemic Etiology and Prognosis in Men and Women with Acute Heart Failure

Coronary heart disease is common in heart failure (HF). Our aim was to determine the impact of ischemic etiology on prognosis among men and women with HF. This study is a prospective national multicenter registry. The primary endpoint was 12-month mortality. Patients with HF and ischemic heart disease were stratified according to sex. A total of 1830 patients were enrolled of which 756 (41.3%) were women. Ischemic etiology was more common in men (446 (41.6%)) than in women (167 (22.2%)). Among patients with ischemic HF, diabetes was more frequent in women than in men. Ischemic etiology was not associated with higher mortality risk, and this was true for women (Hazard Ratio [HR] 1.51, 95% Confidence Interval [CI] 0.98–2.32; p = 0.61) and men (HR 1.14, 95% CI 0.81–1.61; p = 0.46), p-value for interaction: 0.067. Mortality/readmission risk in ischemic HF increased in men with previous readmissions (HR 1.15, 95% CI 1.02–1.29; p = 0.022), chronic obstructive pulmonary disease (HR1.20, 95% CI 1.02–1.41; p = 0.026) and in women with diabetes (HR 2.23, 95% CI 1.05–4.47; p = 0.035). Ischemic etiology was not associated with mortality in HF patients. In ischemic HF, the variables associated with a poor prognosis were diabetes in women and previous readmissions and chronic obstructive pulmonary disease in men.Sin financiación4.241 JCR (2020) Q2, 39/169 Medicine, General & InternalNo data SJR 2020No data IDR 2019UE

Should Advanced Friedreich’s Ataxia Be a Contraindication for Heart Transplantation? A Case Report of a Successful Procedure in a 58-Year-Old Patient

The information on heart transplantation (HT) in patients with Friedreich’s Ataxia (FA) is scarce, and the few published case reports are limited to young patients with mild neurological manifestations. We present the case of a 58-year-old patient with advanced FA (Scale for the Assessment and Rating of Ataxia [SARA] score 30/40), wheelchair-bound for the last 16 years and had urinary incontinence, dysarthria, and neurosensorial deafness. The patient was admitted for a refractory arrhythmic storm and had previous hypertrophic cardiomyopathy that evolved to dilated cardiomyopathy with severely reduced left ventricular ejection fraction and recurrent ventricular arrhythmias. A multidisciplinary team discussed the HT option. The patient was aware of the risks and benefits and considered worthy of the intervention, so he was listed for HT. After a successful surgical intervention, the patient had a long postoperative stay in ICU. He required a high dose of vasopressors, underwent hemofiltration for one month, suffered critical illness myopathy, had several respiratory infections and delayed tracheal extubation. Two and a half months after HT and almost five months at the hospital, the patient was successfully discharged. FA patients with severe heart conditions should be carefully evaluated by a multidisciplinary team to decide the candidacy for HT

Should Advanced Friedreich’s Ataxia Be a Contraindication for Heart Transplantation? A Case Report of a Successful Procedure in a 58-Year-Old Patient

The information on heart transplantation (HT) in patients with Friedreich’s Ataxia (FA) is scarce, and the few published case reports are limited to young patients with mild neurological manifestations. We present the case of a 58-year-old patient with advanced FA (Scale for the Assessment and Rating of Ataxia [SARA] score 30/40), wheelchair-bound for the last 16 years and had urinary incontinence, dysarthria, and neurosensorial deafness. The patient was admitted for a refractory arrhythmic storm and had previous hypertrophic cardiomyopathy that evolved to dilated cardiomyopathy with severely reduced left ventricular ejection fraction and recurrent ventricular arrhythmias. A multidisciplinary team discussed the HT option. The patient was aware of the risks and benefits and considered worthy of the intervention, so he was listed for HT. After a successful surgical intervention, the patient had a long postoperative stay in ICU. He required a high dose of vasopressors, underwent hemofiltration for one month, suffered critical illness myopathy, had several respiratory infections and delayed tracheal extubation. Two and a half months after HT and almost five months at the hospital, the patient was successfully discharged. FA patients with severe heart conditions should be carefully evaluated by a multidisciplinary team to decide the candidacy for HT.Depto. de MedicinaFac. de MedicinaTRUEpu