Article

Diagnóstico y tratamiento de la insuficiencia cardíaca diastólica

Servicio de Cardiología. Hospital Universitario Reina Sofía. Córdoba. España
Revista Espa de Cardiologia (Impact Factor: 3.34). 01/2004; DOI: 10.1016/S0300-8932(04)77147-X
Source: OAI

ABSTRACT La insuficiencia cardíaca diastólica, o con función sistólica conservada, representa entre el 30 y el 50% de todos los casos de insuficiencia cardíaca, y su pronóstico es casi tan desfavorable como el de los pacientes con insuficiencia cardíaca crónica (ICC) con función sistólica deprimida. En la actualidad sólo se exige para su diagnóstico la presencia de criterios clínicos estrictos de insuficiencia cardíaca y una fracción de eyección del ventrículo izquierdo (FEVI) conservada (mayor del 40-50%), aunque la determinación de los valores de péptido natriurético cerebral puede tener interés para el diagnóstico en el futuro. Puesto que no hay evidencia derivada de ensayos clínicos importantes, salvo el ligero beneficio obtenido con candesartán en el estudio CHARM en la reducción de los reingresos, su tratamiento se basa en la identificación y el tratamiento de su etiología (hipertensión arterial, cardiopatía isquémica), el control de la frecuencia cardíaca y el alivio de la congestión, por lo que la combinación de diuréticos a dosis bajas, antihipertensivos bradicardizantes (bloqueadores beta, antagonistas del calcio) y antagonistas de la angiotensina en la actualidad parece ser la mejor estrategia terapéutica.

Full-text

Available from: Soledad Ojeda, Jan 24, 2015
1 Follower
 · 
360 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: La insuficiencia cardíaca es una de las principales causas de muerte cardiovascular y se presenta como consecuencia, en más del 70 por ciento de los casos, de las dos enfermedades cardiovasculares de mayor prevalencia: la hipertensión arterial y la enfermedad coronaria.
    Revista de la Facultad de Medicina, Universidad Nacional de Colombia 06/2006; 54(2):124-133.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Prognosis of chronic heart failure (CHF) continues to be poor, in spite of recent advances lack in therapy. One of the main reasons for this persistent bad prognosis is the not application of recommended drug therapy, perhaps due, at least in part, to the great prevalence of CHF and the complexity of treatment. Disease management programs have shown to improve therapy and prognosis in patients with CHF, decreasing hospital admissions and improving survival. Nevertheless, the cost-benefit effect and the economic impact of such programs are not well known. We performed a prospective trial involving 153 consecutive patients diagnosed of heart failure in 1999 in our hospital, and randomized in two groups: the intervention (n=76) and the control group (n=77). The interventional program was based on the information and education of the patient and its surrounding and the possibillity of free telephonic or personal consultation with our cardiologist. Patients from the control group received usual care. After 15.8±6 months of follow-up, a significant reduction of mortality, heart failure readmissions and hospital stay were observed in the intervention group. The total number of days of hospital stay was 593 in the control group and 114 days in the intervention group, avoiding 479 days of hospital stay in this group. Given a cost of the hospital stay of 421.25 euros/day, the total cost eluded was 216 148.75 euros in 15.8 months, representing savings of 163 953.4 euros in one year. The expenses of the program were 2645.91 euros/month, resulting in savings of 132 202.48 euros/year. In conclusion, the cost to benefit ratio of our program is favorable.
    Revista Espa de Cardiologia 01/2005; 58:32-36. DOI:10.1016/S0300-8932(05)74094-X · 3.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Few studies have been carried out on the specific characteristics of heart failure in women. The proportion of women included in major clinical trials on heart failure is under 20%, while women account for almost half of all hospital admissions for heart failure. Consequently, increased understanding of the actual status of heart failure in women is needed. The aim of this study was to investigate possible sex differences in the prevalence, clinical characteristics, diagnostic assessment, treatment and short- and long-term prognosis of heart failure in Spain. We analyzed data from clinical and observational studies organized by the Section of Heart Failure, Heart Transplantation and Associated Therapies of the Spanish Society of Cardiology during the last 10 years in Spain (i.e., the PRICE, BADAPIC, RAIC and ATIICA studies). The prevalence of heart failure was similar in men and women (6.5% and 7%, respectively). Among patients admitted with acute heart failure (RAIC study), women were older than man, were more likely to have a history of hypertension or diabetes mellitus, were less likely to have a history of coronary heart disease, and were more likely to have heart failure with preserved systolic function. Cardiac catheterization was performed in a smaller proportion of women and they received beta-blockers less frequently. In-hospital mortality and mortality 3 months after discharge were similar in men and women. The demographic, pathophysiological and clinical characteristics found in outpatients with chronic heart failure (BADAPIC study) were similar to those observed in the RAIC study: a smaller proportion of women than men received beta-blockers, angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor antagonists, and lower doses were given. Long-term survival was similar in men and women, though women were more frequently admitted for decompensated heart failure. In the ATIICA study, female sex was found to be an independent predictor of low ACE-inhibitor, but not beta-blocker, use.
    Revista Española de Cardiología Suplementos 01/2008; 8(4). DOI:10.1016/S1131-3587(08)73561-1