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Vol. 57. Issue 2.
Pages 85-96 (April - June 2022)
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Vol. 57. Issue 2.
Pages 85-96 (April - June 2022)
Original article
Risk of outcomes in a Spanish population with heart failure
Riesgo de eventos en una población española con insuficiencia cardiaca
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Nicolás Manitoa, Carlos Escobarb,
Corresponding author
, Beatriz Palaciosc, Luis Varelac, Unai Arandac, Margarita Capelc, Antoni Sicrasd, Aram Sicrasd, Antonio Hormigoe, Roberto Alcázarf, Manuel Botanag
a Servicio de Cardiología, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
b Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
c AstraZeneca, Spain
d Investigación Sobre Economía y Resultados de la Salud, Atrys Health, Barcelona, Spain
e Centro de Salud Puerta Blanca, Málaga, Spain
f Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain
g Servicio de Endocrinología, Hospital Universitario Lucus Augusti, Lugo, Spain
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Tables (5)
Table 1. Clinical characteristics and treatments in the prevalent HF population at index date.
Table 2. Risk of outcomes* between HF vs CKD and HF patients in the prevalent population after 3 years of follow-up.
Table 3. Clinical characteristics and treatments in the incident HF population at baseline.
Table 4. Percentage of patients who developed CKD within 24 months from HF diagnosis.
Table 5. Event rates per 100 patient-year for HF patients diagnosed in 2017 with or without CKD at baseline and followed for 24 months.
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Abstract
Introduction and objectives

To assess mortality, cardiovascular and renal outcomes among patients with heart failure (HF) (primary objective), with a particular focus on the risk of developing chronic kidney disease (CKD) (secondary).

Methods

Observational cohort study, comprising cross-sectional and longitudinal retrospective analyses using secondary data from electronic health records. For the primary objective, adults with prevalent HF, defined as at least one diagnosis of HF prior to the index date (1 January 2017) were included. For the secondary objective, adults with incident HF in 2017 were enrolled.

Results

A total of 21 575 patients had HF in the prevalent population (8391 with CKD at baseline), whereas 3045 patients were included in the incident population. In the prevalent population, the risk of all-cause death (HR, 1.227; 95%CI, 1.172–1.285), CKD hospitalization (HR, 1.427; 95%CI, 1.379–1.479) and acute kidney failure (HR, 1.377; 95%CI, 1.222–1.524) was greater in those patients with HF and CKD vs HF only after 3 years of follow-up. For the incident population, within 24 months from HF diagnosis, 5.9% of patients developed CKD. Overall, 23.4% were taking angiotensin-converting enzyme inhibitors, 26.3% angiotensin receptor blockers, 7.9% sacubitril/valsartan, 64.2% beta blockers, 11.5% aldosterone antagonists and 4.5% sodium-glucose Cotransporter-2 inhibitors.

Conclusions

In Spain, patients with HF have a high risk of developing cardiovascular and renal complications. Despite that, there is a substantial proportion of patients that are not taking guideline recommended drugs. A higher use of these drugs could reduce HF burden and complications in clinical practice.

Keywords:
Cardiovascular
Chronic kidney disease
Death
Heart failure
Sacubitril/valsartan
Renal
SGLT2 inhibitors
Resumen
Introducción y objetivos

Determinar la mortalidad y los eventos cardiovasculares y renales en pacientes con insuficiencia cardiaca (IC) (objetivo primario), en particular sobre el desarrollo de enfermedad renal crónica (ERC) (secundario).

Métodos

Estudio observacional, con análisis transversal y retrospectivo, empleando datos secundarios de registros electrónicos de salud. Para el objetivo primario se incluyeron adultos con IC prevalente, definida como al menos un diagnóstico de IC antes de la fecha índice (1 de enero de 2017). Para el secundario se incluyeron adultos con IC incidente en 2017.

Resultados

Se incluyeron 21.575 pacientes con IC en la población prevalente (8.391 con ERC basal) y 3.045 en la población incidente. En la población prevalente el riesgo de muerte (HR=1,227; IC95%, 1,172-1,285), hospitalización por ERC (HR=1,427; IC95%, 1,379-1,479) y fallo renal agudo (HR=1,377; IC95%, 1,222-1,524) fue mayor en los pacientes con IC y ERC frente a IC sola, tras 3años de seguimiento. En la población incidente, a los 24meses del diagnóstico el 5,9% desarrollaron ERC. Globalmente, el 23,4% tomaban inhibidores de la enzima convertidora de angiotensina, el 26,3% antagonistas de los receptores de angiotensinaII, el 7,9% sacubitrilo/valsartán, el 64,2% bloqueadores beta, el 11,5% antialdosterónicos y el 4,5% inhibidores del cotransportador sodio-glucosa tipo2.

Conclusiones

En España, los pacientes con IC tienen un riesgo elevado de desarrollar complicaciones cardiovasculares y renales. Sin embargo, existe una proporción importante de pacientes que no toman los fármacos recomendados por las guías. Un mayor uso podría reducir la carga de IC y las complicaciones en la práctica clínica.

Palabras clave:
Cardiovascular
Enfermedad renal crónica
Muerte
Insuficiencia cardiaca
Sacubitrilo/valsartán
Renal
Inhibidores SGLT-2

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