Josep Lupón

Publications (40)125.4 Total impact

• Article: Statins in heart failure: not yet the end of the story?

  Paloma Gastelurrutia, Josep Lupón, Antoni Bayes-Genis
  European Journal of Heart Failure 03/2013; · 4.90 Impact Factor
• Article: Combined Use of the Novel Biomarkers High-Sensitivity Troponin T and ST2 for Heart Failure Risk Stratification vs Conventional Assessment.

  Josep Lupón, Marta de Antonio, Amparo Galán, Joan Vila, Elisabet Zamora, Agustín Urrutia, Antoni Bayes-Genis
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  ABSTRACT: OBJECTIVE: To assess an innovative multimarker strategy for risk stratification of death in a real-life ambulatory heart failure (HF) cohort. PATIENTS AND METHODS: The study included 876 consecutive outpatients (median age, 70.3 years; left ventricular ejection fraction, 34%) between May 22, 2006, and July 7, 2010, prospectively followed up in a structured HF unit. A combination of biomarkers reflecting myocardial stretch (N-terminal pro-B-type natriuretic peptide [NT-proBNP]), myocyte injury (high-sensitivity cardiac troponin T [hs-cTnT]), and ventricular fibrosis and remodeling (high-sensitivity ST2 [hs-ST2]) were added to an assessment based on established mortality risk factors (age, sex, left ventricular ejection fraction, New York Heart Association functional class, diabetes mellitus, estimated glomerular filtration rate, ischemic etiology, sodium level, hemoglobin level, and pharmacologic treatment). RESULTS: During median follow-up of 41.4 months, 311 patients died. The combined addition of hs-cTnT and hs-ST2 to the model yielded good measurements of performance (C statistic, 0.789; Bayesian information criterion, 3611; integrated discrimination improvement, 4.1 [95% CI, 2.5-5.6]; and net reclassification index, 13.9% [95% CI, 6.2-21.6]). Reclassification did not significantly benefit after NT-proBNP addition into the full model; some indices even worsened with all 3 biomarkers. Separate addition of NT-proBNP provided prognostic discrimination only in the subgroup of patients with either hs-cTnT or hs-ST2 levels below the cutoff points (hazard ratio, 2.97; 95% CI, 2.24-9.39; P<.001). CONCLUSION: A multimarker strategy seems useful for stratifying risk in chronic HF. However, NT-proBNP in addition to the new-generation biomarkers hs-cTnT and hs-ST2 had a limited effect on risk stratification.
  Mayo Clinic Proceedings 02/2013; · 5.70 Impact Factor
• Article: Quality of life monitoring in ambulatory heart failure patients: temporal changes and prognostic value.

  Josep Lupón, Paloma Gastelurrutia, Marta de Antonio, Beatriz González, Lucía Cano, Roser Cabanes, Agustín Urrutia, Crisanto Díez, Ramón Coll, Salvador Altimir, Antoni Bayes-Genis
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  ABSTRACT: AIMS: Heart failure (HF) is a chronic condition that typically affects a patient's quality of life (QoL). Little is known about long-term QoL monitoring in HF. This study aimed to evaluate the temporal changes and prognostic value of QoL assessment in a real-life cohort of HF patients. METHODS AND RESULTS: The Minnesota Living with Heart Failure Questionnaire was used to monitor QoL at baseline and at 1, 3, and 5 years for 1151 consecutive patients {71.7% men, median age 69 years [25th-75th percentiles (P(25)-P(75)) 59-76]} in an HF unit. Follow-up for prognosis assessment was extended to 6 years. The number of answered questionnaires was 1151 at baseline, 746 at 1 year, 268 at 3 years, and 240 at 5 years. QoL scores showed a steep decrease (indicating QoL improvement) during the first year [29 (P(25)-P(75) 16-43) at baseline vs. 15 (P(25)-P(75) 8-27) at 1 year, P < 0.001], which was tempered, yet significant up to 5 years [12 (P(25)-P(75) 7-23) at 3 years vs. 10 (P(25)-P(75) 5-21) at 5 years, P = 0.012]. We recorded 457 deaths during follow-up. In a comprehensive multivariable Cox regression analysis, baseline QoL remained a significant prognosticator during follow-up [hazard ratio (HR)(Cox) for death 1.012, 95% confidence interval 1.006-1.018, P < 0.001]. QoL monitoring showed that a score increase ≥10% between consecutive assessments stratified high-risk patients within the next 12 months (P = 0.008). CONCLUSION: Both baseline and follow-up QoL monitoring were useful for patient risk stratification in a real-life HF cohort. Worse QoL may warn of a worse prognosis. Widespread QoL monitoring in routine clinical practice is recommended.
  European Journal of Heart Failure 08/2012; · 4.90 Impact Factor
• Article: Statins in heart failure: the paradox between large randomized clinical trials and real life.

  Paloma Gastelurrutia, Josep Lupón, Marta de Antonio, Agustin Urrutia, Crisanto Díez, Ramón Coll, Salvador Altimir, Antoni Bayes-Genis
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  ABSTRACT: To assess the relationship between statins and prognosis in ischemic and nonischemic patients with heart failure (HF) in a real-life cohort followed up for a long period. This prospective study included 960 patients with HF with preserved or depressed left ventricular ejection fraction (LVEF), irrespective of HF etiology, who were referred to the HF clinic of a university hospital between August 1, 2001, and December 31, 2008. The patients were followed up for a maximum of 9.1 years (median, 3.7 years), and survival in ischemic and nonischemic patients was determined. Median age was 69 years, and median LVEF was 31%. Of the 960 patients, 532 (55.4%) had ischemic HF etiology, and most received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (846; 88.1%) and β-blockers (776; 80.8%). Patients with HF of ischemic origin were more often treated with statins (P<.001). During follow-up, 440 patients (45.8%) died. Statin therapy was associated with significantly improved survival (hazard ratio, 0.45 [95% confidence interval, 0.37-0.54]; P<.001). After adjustment for HF prognostic factors (age, sex, cholesterol level, New York Heart Association class, HF etiology, LVEF, body mass index, HF duration, atrial fibrillation, implantable cardioverter-defibrillator therapy, and medicines), statins remained significantly associated with lower mortality risk in both ischemic (P=.007) and nonischemic (P=.002) patients. In contrast to results of large randomized trials, statins were independently and significantly associated with lower mortality risk in our real-life HF cohort, including patients with nonischemic HF etiology.
  Mayo Clinic Proceedings 06/2012; 87(6):555-60. · 5.70 Impact Factor
• Article: Estimated glomerular filtration rate and prognosis in heart failure: value of the Modification of Diet in Renal Disease Study-4, chronic kidney disease epidemiology collaboration, and cockroft-gault formulas.

  Elisabet Zamora, Josep Lupón, Joan Vila, Agustín Urrutia, Marta de Antonio, Hèctor Sanz, Maria Grau, Jordi Ara, Antoni Bayés-Genís
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  ABSTRACT: The purpose of this study was to assess the value of estimated glomerular filtration rate (eGFR) calculated by different formulas for predicting the risk of death in heart failure (HF) outpatients. Patients with both HF and renal insufficiency have a poor prognosis. Three formulas are mostly used to assess renal function: Cockroft-Gault formula, MDRD-4 (Modification of Diet in Renal Disease Study) formula, and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. The prognostic values of these formulas have not been adequately compared in HF patients. A total of 925 patients (72% men; age 69 years; interquartile range: 59 to 75.5 years) with a left ventricular ejection fraction of 31% (interquartile range: 23.5% to 39%) were studied. Follow-up was 1,202 days (interquartile range: 627.5 to 2,156.5 days). Measures of performance were evaluated using continuous data and by dividing patients into 4 subgroups according to the eGFR: ≥90, 89 to 60, <60 to 30, and <30 ml/min/1.73 m(2). The 3 formulas correlated significantly, with the best correlation found between the MDRD-4 and CKD-EPI formulas. The 3 formulas afforded independent prognostic information over long-term follow-up. However, risk prediction was most accurate using the Cockroft-Gault formula as evaluated by Cox proportional hazards models (hazard ratio: 0.75 vs. 0.81 with the MDRD-4 formula and 0.80 with the CKD-EPI equation), area under the curve (0.67 vs. 0.62 and 0.64, respectively), and Bayesian information criterion (both analyzing eGFR as a continuous or categorical variable). Indeed, net reclassification improvement and integrated discrimination improvement using the Cockroft-Gault formula were 21% and 5.04, respectively, versus the MDRD-4 formula (the most used) and 13.1% and 3.77 respectively versus CKD-EPI equation (the more recent) (all p values <0.001). In this ambulatory, real-life cohort of HF patients, the Cockroft-Gault formula was the most accurate of the 3 used eGFR formulas to improve the risk stratification for death.
  Journal of the American College of Cardiology 05/2012; 59(19):1709-15. · 14.16 Impact Factor
• Article: Rapid point-of-care NT-proBNP optimal cut-off point for heart failure diagnosis in primary care.

  José M Verdú, Josep Comín-Colet, Mar Domingo, Josep Lupón, Miguel Gómez, Luis Molina, Jose M Casacuberta, Miguel A Muñoz, Amparo Mena, Jordi Bruguera-Cortada
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  ABSTRACT: Measurement of natriuretic peptides may be recommended prior to echocardiography in patients with suspected heart failure. Cut-off point for heart failure diagnosis in primary care is not well established. We aimed to assess the optimal diagnostic cut-off value of N-terminal pro-B-type natriuretic peptide on a community population attended in primary care. Prospective diagnostic accuracy study of a rapid point-of-care N-terminal pro-B-type natriuretic peptide test in a primary healthcare centre. Consecutive patients referred by their general practitioners to echocardiography due to suspected heart failure were included. Clinical history and physical examination based on Framingham criteria, electrocardiogram, chest X-ray, N-terminal pro-B-type natriuretic peptide measurement and echocardiogram were performed. Heart failure diagnosis was made by a cardiologist blinded to N-terminal pro-B-type natriuretic peptide value, using the European Society of Cardiology diagnosis criteria (clinical and echocardiographic data). Of 220 patients evaluated (65.5% women; median 74 years [interquartile range 67-81]). Heart failure diagnosis was confirmed in 52 patients (23.6%), 16 (30.8%) with left ventricular ejection fraction <50% (39.6 [5.1]%). Median values of N-terminal pro-B-type natriuretic peptide were 715 pg/mL [interquartile range 510.5-1575] and 77.5 pg/mL [interquartile range 58-179.75] for patients with and without heart failure respectively. The best cut-off point was 280 pg/mL, with a receiver operating characteristic curve of 0.94 (95% confidence interval, 0.91-0.97). Six patients with heart failure diagnosis (11.5%) had N-terminal pro-B-type natriuretic peptide values <400 pg/mL. Measurement of natriuretic peptides would avoid 67% of requested echocardiograms. In a community population attended in primary care, the best cut-off point of N-terminal pro-B-type natriuretic peptide to rule out heart failure was 280 pg/mL. N-terminal pro-B-type natriuretic peptide measurement improve work-out diagnoses and could be cost-effectiveness.
  Revista Espanola de Cardiologia 04/2012; 65(7):613-9.
• Article: Depression, antidepressants, and long-term mortality in heart failure.

  Crisanto Diez-Quevedo, Josep Lupón, Beatriz González, Agustín Urrutia, Lucía Cano, Roser Cabanes, Salvador Altimir, Ramon Coll, Teresa Pascual, Marta de Antonio, Antoni Bayes-Genis
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  ABSTRACT: BACKGROUND: This study was designed to assess whether depression and the use of antidepressants were related to long-term mortality in heart failure. METHODS: Heart failure outpatients (n=1017) from a specialized tertiary unit in Spain were prospectively studied for a median follow-up of 5.4years (IQR 3.1-8.1). Depressive symptoms were assessed using an abbreviated version of the geriatric depression scale. Survival rates during the study period (August 2001 until December 2010) and hazard ratios (HR) for mortality were adjusted by several demographic and clinical variables. RESULTS: Depressive symptoms were detected in 302 patients (29.7%) at baseline and 222 (21.8%) de novo during follow-up; 304 patients (29.9%) received at least one prescription of antidepressants, mainly selective serotonin reuptake inhibitors (92.8%); 441 patients (43.4%) died. In a multivariate Cox proportional hazard model, depression was associated with an increased all-cause (HR, 1.39; 95% CI, 1.15-1.68), but not cardiovascular, mortality risk after adjustment for several demographic and clinical confounders. The use of any antidepressant was not independently associated with mortality (HR, 0.89; 95% CI, 0.71-1.13), but benzodiazepines showed a protective role (HR, 0.70; 95% CI, 0.57-0.87). On the contrary, fluoxetine prescriptions, but not duration of fluoxetine treatment, were associated with increased mortality (HR, 1.66; 95% CI, 1.13-2.44) CONCLUSIONS: Depressive symptoms are associated with long-term mortality, but the use of antidepressants and benzodiazepines is safe regarding survival in HF patients, although further research is needed considering individual antidepressants separately.
  International journal of cardiology 04/2012; · 7.08 Impact Factor
• Article: Undernourishment and prognosis in heart failure.

  Paloma Gastelurrutia, Josep Lupón, Antoni Bayes-Genis
  Revista Espa de Cardiologia 02/2012; 65(2):196-7. · 2.53 Impact Factor
• Article: Combined use of high-sensitivity ST2 and NTproBNP to improve the prediction of death in heart failure.

  Antoni Bayes-Genis, Marta de Antonio, Amparo Galán, Héctor Sanz, Agustin Urrutia, Roser Cabanes, Lucía Cano, Beatriz González, Cristanto Díez, Teresa Pascual, Roberto Elosúa, Josep Lupón
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  ABSTRACT: To address the incremental usefulness of biomarkers from different disease pathways for predicting risk of death in heart failure (HF). We used data from consecutive patients treated at a structured multidisciplinary HF unit to investigate whether a combination of biomarkers reflecting ventricular fibrosis, remodelling, and stretch [ST2 and N-terminal pro brain natriuretic peptide (NTproBNP)] improved the risk stratification of a HF patient beyond an assessment based on established mortality risk factors (age, sex, ischaemic aetiology, left ventricular ejection fraction, New York Heart Association functional class, diabetes, glomerular filtration rate, sodium, haemoglobin, and beta-blocker and angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker treatments). ST2 was measured with a novel high-sensitivity immunoassay. During a median follow-up time of 33.4 months, 244 of the 891 participants in the study (mean age 70.2 years at baseline) died. In the multivariable Cox proportional hazards model, both ST2 and NTproBNP significantly predicted the risk of death. The individual inclusion of ST2 and NTproBNP in the model with established mortality risk factors significantly improved the C statistic for predicting death [0.79 (0.76-0.81); P < 0.001]. The net improvement in reclassification after the separate addition of ST2 to the model with established risk factors and NTproBNP was estimated at 9.90% [95% confidence interval (CI) 4.34-15.46; P < 0.001] and the integrated discrimination improvement at 1.54 (95% CI 0.29-2.78); P = 0.015). Our data suggest that in a real-life cohort of HF patients, the addition of ST2 and NTproBNP substantially improves the risk stratification for death beyond that of a model that is based only on established mortality risk factors.
  European Journal of Heart Failure 01/2012; 14(1):32-8. · 4.90 Impact Factor
• Article: Limited Value of Cystatin-C over Estimated Glomerular Filtration Rate for Heart Failure Risk Stratification.

  Elisabet Zamora, Josep Lupón, Marta de Antonio, Joan Vila, Amparo Galán, Paloma Gastelurrutia, Agustín Urrutia, Antoni Bayes-Genis
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  ABSTRACT: To compare the prognostic value of estimated glomerular filtration rate, cystatin-C, an alternative renal biomarker, and their combination, in an outpatient population with heart failure.Estimated glomerular filtration rate is routinely used to assess renal function in heart failure patients. We recently demonstrated that the Cockroft-Gault formula is the best among the most commonly used estimated glomerular filtration rate formulas for predicting heart failure prognosis. A total of 879 consecutive patients (72% men, age 70.4 years [P(25-75) 60.5-77.2]) were studied. The etiology of heart failure was mainly ischemic heart disease (52.7%). The left ventricular ejection fraction was 34% (P(25-75) 26-43%). Most patients were New York Heart Association class II (65.8%) or III (25.9%). During a median follow-up of 3.46 years (P(25-75) 1.85-5.05), 312 deaths were recorded. In an adjusted model, estimated glomerular filtration rate and cystatin-C showed similar prognostic value according to the area under the curve (0.763 and 0.765, respectively). In Cox regression, the multivariable analysis hazard ratios were 0.99 (95% CI: 0.98-1, P = 0.006) and 1.14 (95% CI: 1.02-1.28, P = 0.02) for estimated glomerular filtration rate and cystatin-C, respectively. Reclassification, assessed by the integration discrimination improvement and the net reclassification improvement indices, was poorer with cystatin-C (-0.5 [-1.0;-0.1], P = 0.024 and -4.9 [-8.8;-1.0], P = 0.013, respectively). The value of cystatin-C over estimated glomerular filtration rate for risk-stratification only emerged in patients with moderate renal dysfunction (eGFR 30-60 ml/min/1.73 m(2), chi-square 12.9, P<0.001). Taken together, the results indicate that estimated glomerular filtration rate and cystatin-C have similar long-term predictive values in a real-life ambulatory heart failure population. Cystatin-C seems to offer improved prognostication in heart failure patients with moderate renal dysfunction.
  PLoS ONE 01/2012; 7(12):e51234. · 4.09 Impact Factor
• Article: The obesity paradox in heart failure: Is etiology a key factor?

  Elisabet Zamora, Josep Lupón, Marta de Antonio, Agustín Urrutia, Ramon Coll, Crisanto Díez, Salvador Altimir, Antoni Bayés-Genís
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  ABSTRACT: BACKGROUND: Obesity is paradoxically associated with survival in patients with heart failure (HF). Our objective was to assess whether the relationship between body mass index (BMI) and long-term survival is associated with HF etiology (ischemic vs. non-ischemic) in a cohort of ambulatory HF patients. METHODS: BMI and survival status after a median follow-up of 6.1years (IQR 2.2-7.8) were available for 504 patients (73% men; median age 68years [IQR 58-74]). Fifty-nine percent of patients had ischemic etiology. Median left ventricular ejection fraction (LVEF) was 30% (IQR 23-39.7%). Most patients were in NYHA functional class II (51%) or III (42%). Patients were divided into four groups according to BMI: low weight (BMI<20.5kg/m(2)), normal weight (BMI 20.5 to<25.5kg/m(2)), overweight (BMI 25.5 to<30kg/m(2)), and obese (BMI≥30kg/m(2)). RESULTS: Mortality differed significantly across the BMI strata in non-ischemic patients (log-rank p<0.0001) but not in ischemic patients. Using normal weight patients as a reference, hazard ratios for low weight, overweight, and obese patients were 2.08 (1.16-3.75, p=0.014), 0.88 (0.54-1.43, p=0.60), and 0.49 (0.28-0.86, p=0.01), respectively, for non-ischemic patients and 1.19 (0.48-2.97, p=0.71), 0.88 (0.61-1.27, p=0.48), and 0.96 (0.66-1.41, p=0.85), respectively, for ischemic patients. After adjusting for age, sex, NYHA functional class, LVEF, co-morbidities, and treatment, BMI remained an independent predictor of survival in non-ischemic patients. CONCLUSION: Over long-term follow-up of ischemic and non-ischemic HF, the obesity paradox was only observed in patients with non-ischemic HF.
  International journal of cardiology 12/2011; · 7.08 Impact Factor
• Article: Noninvasive Remote Telemonitoring for Ambulatory Patients With Heart Failure and Emergency Department Services. Response.

  Mar Domingo, Josep Lupón, Antoni Bayes-Genis
  Revista Espa de Cardiologia 08/2011; · 2.53 Impact Factor
• Article: Usefulness of body mass index to characterize nutritional status in patients with heart failure.

  Paloma Gastelurrutia, Josep Lupón, Maite Domingo, Nuria Ribas, Mariana Noguero, Cecilia Martinez, Mariano Cortes, Antoni Bayes-Genis
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  ABSTRACT: The obesity paradox in heart failure (HF) is criticized because of the limitations of body mass index (BMI) in correctly characterizing overweight and obese patients, necessitating a better evaluation of nutritional status. The aim of this study was to assess nutritional status, BMI, and significance in terms of HF survival. Anthropometry and biochemical nutritional markers were assessed in 55 HF patients. Undernourishment was defined as the presence of ≥2 of the following indexes below the normal range: triceps skinfold, subscapular skinfold, arm muscle circumference, albumin, and total lymphocyte count. Patients were also stratified by BMI and followed for a median of 26.7 months. Across BMI strata, no patient was underweight, 31% were normal weight, 42% were overweight, and 27% were obese. Undernourishment was present in 53% of normal-weight patients, 22% of overweight patients, and none of the obese patients (p = 0.001). Undernourished patients had significantly higher mortality (p = 0.009) compared to well-nourished patients. In multivariate analysis, only undernutrition (hazard ratio 3.149, 95% confidence interval 1.367 to 7.253), New York Heart Association functional class (hazard ratio 3.374, 95% confidence interval 1.486 to 7.659), and age (hazard ratio 1.115, 95% confidence interval 1.045 to 1.189) remained in the model. Among nutritional indicators, subscapular skinfold was the best predictor of mortality; patients with subscapular skinfold in the fifth percentile had higher mortality (p = 0.0001). In conclusion, BMI does not indicate true nutritional status in HF. Classifying patients as well nourished or undernourished may improve risk stratification.
  The American journal of cardiology 07/2011; 108(8):1166-70. · 3.58 Impact Factor
• Article: [Noninvasive remote telemonitoring for ambulatory patients with heart failure: effect on number of hospitalizations, days in hospital, and quality of life. CARME (CAtalan Remote Management Evaluation) study].

  Mar Domingo, Josep Lupón, Beatriz González, Eva Crespo, Raúl López, Anna Ramos, Agustín Urrutia, Guillem Pera, José M Verdú, Antoni Bayes-Genis
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  ABSTRACT: Multidisciplinary strategies for the management of heart failure (HF) improve outcomes. We aimed to evaluate the effectiveness of noninvasive home telemonitoring in ambulatory patients with HF already included in a structured multidisciplinary HF program. Prospective intervention study with before/after comparison design of an interactive telemedicine platform in HF patients, randomized 1:1 into two groups: A) Motiva System with educational videos, motivational messages, and questionnaires, and B) Motiva System + self monitoring of blood pressure, heart rate, and weight. Hospitalizations were compared over 12 months prior to and post study inclusion. Quality of life was evaluated using the generic EuroQoL visual analogue scale and the specific questionnaire Minnesota Living With Heart Failure Questionnaire. There were 92 patients included (71% male; 66.3 ± 11.5 years; 71% ischemic aetiology). During real-time telemonitoring over 11.8 months (interquartile range 8.6-12), 14,730 questionnaires were administered with 89% median response rate. Hospitalizations for HF decreased by 67.8% (P = .010) and for other cardiac causes by 57.6% (P = .028). The number of days in hospital for HF decreased by 73.3% (P =.036), without statistically significant differences between groups, and for other cardiac causes by 82.9% (P =.008). The perception of quality of life improved significantly both for the generic scale (P < .001) and for the HF specific questionnaire (P=.005). HF patients who used an interactive telehealth system with motivational support tools at home spent less time in hospital and felt their quality of life had significantly improved. No significant differences were observed between groups.
  Revista Espa de Cardiologia 03/2011; 64(4):277-85. · 2.53 Impact Factor
• Article: Evaluation of a telemedicine system for heart failure patients: Feasibility, acceptance rate, satisfaction and changes in patient behavior Results from the CARME (CAtalan Remote Management Evaluation) study.

  Mar Domingo, Josep Lupón, Beatriz González, Eva Crespo, Raúl López, Anna Ramos, Agustín Urrutia, Guillem Pera, José M Verdú, Antoni Bayes-Genis
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  ABSTRACT: BACKGROUND: Telemedicine can be useful for managing heart failure (HF), but patient acceptance of telemedicine and its impact on patient behavior are unclear. AIMS: To assess a telemedicine program in a HF Unit. METHODS AND RESULTS: This sub-analysis of the CARME study assessed the use of an interactive telemedicine platform. This prospective intervention study had a before/after design with HF patients randomized 1:1 into two groups: A) Motiva system (educational videos, motivational messages, and questionnaires); and B) Motiva system+telemonitoring of blood pressure, heart rate and weight. Of 211 patients screened, 44 were excluded, 62 did not consent to participate and 8 withdrew consent prior to installation of the system. The final study population included 97 patients. During 1year of follow-up, 22 patients voluntarily discontinued use of the system, 5 died (three after early discontinuation) and 5 withdrew consent before the last evaluation. A total of 15,017 questionnaires were sent to patients, with a median response rate of 88%. Satisfaction with the system and tools was high (median score 8.4/10), especially with the self-monitoring chart, scale and sphygmomanometer. Positive changes were observed in patient behavior, especially for blood pressure and weight control (p<0.001). After the study, 65% of the patients wished to continue with telemonitoring, particularly those in Group B (p=0.004). CONCLUSION: Less than half of our patients participated in the telemedicine study. However, those who completed the study had confidence in the system, a high degree of satisfaction with the tools and positive behavioral changes.
  European journal of cardiovascular nursing: journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 03/2011;
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  Available from: revespcardiol.org

  Article: Validation of the Spanish version of the Kansas city cardiomyopathy questionnaire.

  Josep Comín-Colet, Olatz Garin, Josep Lupón, Nicolás Manito, Marisa G Crespo-Leiro, Manuel Gómez-Bueno, Montse Ferrer, Remei Artigas, Antonio Zapata, Roberto Elosua
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  ABSTRACT: The Kansas City Cardiomyopathy Questionnaire (KCCQ) is specifically designed to evaluate quality of life in patients with chronic heart failure (CHF). The purpose of this study was to assess the reliability, validity, and responsiveness to change of the Spanish version of the KCCQ. The multicenter study involved 315 patients with CHF. Patients were evaluated at baseline and at weeks 24 and 26. The KCCQ, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and the Short Form-36 (SF-36) were administered. Reliability was assessed in stable patients (n=163) by examining test-retest and internal consistency measures between weeks 24 and 26. Validity was evaluated at baseline (n=315) by determining how KCCQ scores varied with New York Heart Association functional class and by comparing scores with those on similar domains of the MLHFQ and SF-36. Responsiveness to change was assessed in patients who experienced significant clinical improvement between baseline and week 24 (n=31) by determining the effect size. Reliability coefficients ranged between 0.70 and 0.96 for the different domains. Mean KCCQ scores varied significantly with New York Heart Association functional class (P<.001). Correlations with comparable domains on the other questionnaires were acceptable (e.g. for physical limitation, they were between 0.77 and 0.81). The changes observed at 24 weeks in the majority of KCCQ scores in the subsample that improved corresponded to a moderate effect size (i.e. 0.4-0.6). The Spanish version of the KCCQ has good metric properties (i.e. validity, reliability and responsiveness), which make it suitable for use in evaluating quality of life in Spanish CHF patients.
  Revista Espa de Cardiologia 01/2011; 64(1):51-8. · 2.53 Impact Factor
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  Available from: oxfordjournals.org

  Article: Myostatin serum levels in heart failure.

  Elisabet Zamora, Josep Lupón, Rafael Simó, Amparo Galán
  European Journal of Heart Failure 12/2010; 12(12):1379; author reply 1379-80. · 4.90 Impact Factor
• Article: Obesity and long-term prognosis in heart failure: the paradox persists.

  Elisabet Zamora, Josep Lupón, Agustín Urrutia, Antoni Bayes-Genis
  Revista Espa de Cardiologia 10/2010; 63(10):1210-2. · 2.53 Impact Factor
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  Available from: revespcardiol.org

  Article: Serum myostatin levels in chronic heart failure.

  Elisabet Zamora, Rafael Simó, Josep Lupón, Amparo Galán, Agustín Urrutia, Beatriz González, Dolores Mas, Vicente Valle
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  ABSTRACT: Muscle wasting is common in advanced heart failure. Myostatin is an important modulator of muscle catabolism. We measured serum levels of myostatin and its propeptide in patients with chronic heart failure and analyzed their relationships with clinical parameters and prognosis. The study included 70 patients: 30 in New York Heart Association (NYHA) functional class I-II and 40 in class III-IV. Their mean ejection fraction was 32%+/-12%. The mean follow-up time was 17.9+/-1.3 months. Thirteen patients (18.6%) died. No correlation was found between myostatin and myostatin propeptide levels. Nor was the myostatin or myostatin propeptide level correlated with age, sex, left ventricular ejection fraction, symptom duration, or the level of N-terminal probrain natriuretic peptide (NT-proBNP) or tumor necrosis factor-alpha receptor type-2 (TNFalpha R2). Moreover, no relationship was observed between the myostatin or myostatin propeptide level and NYHA functional class or mortality, in contrast to the relationships found with NT-proBNP (P< .001 and P< .001, respectively) and TNFalpha R2 (P=.001 and P=.005, respectively) levels. In conclusion, there was no relationship between the myostatin or myostatin propeptide level and any parameter of disease severity or prognosis in patients with chronic heart failure.
  Revista Espa de Cardiologia 08/2010; 63(8):992-6. · 2.53 Impact Factor
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  Available from: revespcardiol.org

  Article: Mortality and cause of death in patients with heart failure: findings at a specialist multidisciplinary heart failure unit.

  Ferran Pons, Josep Lupón, Agustín Urrutia, Beatriz González, Eva Crespo, Crisanto Díez, Lucía Cano, Roser Cabanes, Salvador Altimir, Ramón Coll, Teresa Pascual, Vicente Valle
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  ABSTRACT: Heart failure mortality is similar to or even higher than that due to various cancers. It is usually associated with disease progression, though sudden death has also been reported as a frequent cause of mortality. The objectives of this study were to investigate mortality and its causes in outpatients with heart failure of different etiologies who were treated in a specialist multidisciplinary unit, and to identify associated factors. The follow-up cohort study (median duration 36 months) involved 960 patients (70.9% male; median age 69 years; ejection fraction 31%; and the majority had an ischemic etiology and were in functional class II or III). Overall, 351 deaths (36.5%) occurred: 230 due to cardiovascular causes (65.5%), mainly heart failure (33.2%) and sudden death (16%); 94 due to non-cardiovascular causes (26.8%), mainly malignancies (10.5%) and septic processes (6.8%); and 27 (7.7%) due to unknown causes. Mortality was independently associated with age, sex, functional class, ejection fraction, time since symptom onset, ischemic etiology, diabetes, creatinine clearance rate, peripheral vascular disease, fragility, and the absence of treatment with an angiotensin-converting enzyme inhibitor or angiotensin-II receptor blocker, beta-blockers, statins or antiplatelet agents. The principal factor associated with cardiovascular death was an ischemic etiology. No factor studied clearly predicted sudden death. Even though mortality in patients treated at a specialist heart failure unit was not low, a quarter died from non-cardiovascular causes. The principal factor associated with cardiovascular death was an ischemic etiology. Only 5.8% of the study population experienced sudden death.
  Revista Espa de Cardiologia 03/2010; 63(3):303-14. · 2.53 Impact Factor