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Tendencias Temporales En Las Características, Tratamiento Y Resultados De La Insuficiencia Cardiaca En Octogenarios Durante Dos Décadas

Revista Española de Cardiología(2022)

Heart Failure Working Group | Cardiology Division | Department of Cardiovascular Sciences Cardiology | ANMCO Research Center | Intensive Cardiac Care Unit Cardiology and Hemodynamics | Department of Cardiology | De Gasperis Cardio Center and Transplant Center | Severe Heart Failure Unit | Cardiology and Cardiac Rehabilitation | Heart Failure Unit | Cardiology Department with Intensive Cardiac Care Unit and Hemodynamics | Heart Failure and Cardiomyopathies Department | Cardiology Division Villa Sofia-Regional reference Center for the Diagnosis and Treatment of Heart Failure | Cardiology Unit

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Abstract
Los octogenarios representan el segmento de población de más rápida expansión en Europa; la prevalencia de la insuficiencia cardiaca (IC) en este grupo supera el 10%. Se evaluaron los cambios en las características clínicas, el tratamiento y los resultados a un año durante dos décadas en pacientes ambulatorios con IC crónica de edad ≥ 80 años incluidos en un registro nacional de cardiología. Se incluyó a 2 520 octogenarios con mediciones de la fracción de eyección ecocardiográfica basal y seguimiento a 1 año disponibles, inscritos en 138 clínicas ambulatorias de IC (21% de los hospitales nacionales con unidades de cardiología), reclutados a lo largo de tres épocas (1999-2005, 2006-2011, 2012-2018). En el momento de la inclusión, a lo largo de los 3 periodos de estudio, aumentaron la edad, el índice de masa corporal, la fracción de eyección, la prevalencia de obesidad, diabetes, dislipemia, hipertensión preexistente y la historia de fibrilación auricular. La proporción de pacientes con fracción de eyección conservada aumentó del 19,4% al 32,7% (p de tendencia < 0,0001). Los marcadores de enfermedad avanzada se hicieron menos prevalentes. La prescripción de bloqueadores beta y antagonistas de los receptores de mineralocorticoides aumentó con el tiempo. Durante el seguimiento a un año, 308 pacientes fallecieron (12,2%) y 360 (14,3%) fueron ingresados por causas cardiovasculares; en total, 591 (23,5%) alcanzaron el objetivo primario combinado de mortalidad por todas las causas u hospitalización cardiovascular. Mediante un análisis multivariable ajustado, la inclusión en 2006-2011 (HR = 0,70; IC95%, 0,55-0,90; p = 0,004) y 2012-2018 (HR = 0,61; IC95%, 0,47-0,79; p = 0,0002), conllevó un menor riesgo del resultado primario que la inclusión en el periodo 1999-2005. Entre los octogenarios, a lo largo de 2 décadas, la prevalencia de los factores de riesgo aumentó, las estrategias de tratamiento mejoraron, la supervivencia se mantuvo estable, pero la proporción de hospitalizados por causas cardiovasculares disminuyó. A pesar de la creciente complejidad clínica, en el ámbito de la cardiología la carga de hospitalizaciones en los ancianos con IC crónica está disminuyendo. Octogenarians represent the most rapidly expanding population segment in Europe. The prevalence of heart failure (HF) in this group exceeds 10%. We assessed changes in clinical characteristics, therapy, and 1-year outcomes over 2 decades in chronic HF outpatients aged ≥ 80 years enrolled in a nationwide cardiology registry. We included 2520 octogenarians with baseline echocardiographic ejection fraction measurements and available 1-year follow-up, who were recruited at 138 HF outpatient clinics (21% of national hospitals with cardiology units), across 3 enrolment periods (1999-2005, 2006-2011, 2012-2018). At recruitment, over the 3 study periods, there was an increase in age, body mass index, ejection fraction, the prevalence of obesity, diabetes, dyslipidemia, pre-existing hypertension, and atrial fibrillation history. The proportion of patients with preserved ejection fraction rose from 19.4% to 32.7% ( P for trend < .0001). Markers of advanced disease became less prevalent. Prescription of beta-blockers and mineralocorticoid receptor antagonists increased over time. During the 1-year follow-up, 308 patients died (12.2%) and 360 (14.3%) were admitted for cardiovascular causes; overall, 591 (23.5%) met the combined primary endpoint of all-cause mortality or cardiovascular hospitalization. On adjusted multivariable analysis, enrolment in 2006 to 2011 (HR, 0.70; 95%CI, 0.55-0.90; P = .004) and 2012 to 2018 (HR, 0.61; 95%CI, 0.47-0.79; P = .0002) carried a lower risk of the primary outcome than recruitment in 1999 to 2005. Among octogenarians, over 2 decades, risk factor prevalence increased, management strategies improved, and survival remained stable, but the proportion hospitalized for cardiovascular causes declined. Despite increasing clinical complexity, in cardiology settings the burden of hospitalizations in the oldest old with chronic HF is declining.
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Octogenarios,Insuficiencia cardiaca crónica,Tendencias temporales,Resultados,Polifarmacia
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要点】:研究评估了在过去二十年里,80岁以上慢性心衰患者的临床特征、治疗方法和一年内结果的变化,发现尽管临床复杂性增加,但住院负担有所下降,治疗策略得到改善,生存率保持稳定。

方法】:通过回顾性分析一个包含2520名80岁以上心衰患者的全国性心血管登记数据,这些患者分布在三个不同的时期(1999-2005,2006-2011,2012-2018)被纳入研究。

实验】:研究使用了全国性心血管登记数据,跟踪了患者的一年生存率和心血管住院情况,发现2006-2011年和2012-2018年期间入组的患者相对于1999-2005年期间入组的患者,主要结局的风险较低。