Demographic Aging – ABC CARDIOL

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Research Letter

The Challenges of Heart Failure Yesterday, Today and Tomorrow and the 20 Years of DEIC

Evandro Tinoco Mesquita et al. Ana Paula Mendes Lidia Moura José Albuquerque de Figueiredo Neto … Fabiana G. Marcondes-Braga Fernando Bacal Maria da Consolação Vieira Moreira Nadine Oliveira Clausell

The Department of Heart Failure of the Brazilian Society of Cardiology (DEIC) completes 20 years in 2020 and represents a robust legacy of scientific activities and associations of Brazilian cardiology.

Its foundation represented an important milestone in the fight against heart failure (HF), a complex progressive and often fatal clinical syndrome. HF should be addressed in a multidisciplinary way, supported by translational science and good practices (clinical guidelines and protocols), involving patients, families, caregivers, managers and the whole society, in view of its social impacts in Brazil and in the world.

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Original Article

Causes and Predictors of In-Hospital Mortality in Patients Admitted with or for Heart Failure at a Tertiary Hospital in Brazil

André Wajner et al. Priccila Zuchinali Vírgilio Olsen Carisi A. Polanczyk Luis Eduardo Rohde

Abstract

Background:

Although heart failure (HF) has high morbidity and mortality, studies in Latin America on causes and predictors of in-hospital mortality are scarce. We also do not know the evolution of patients with compensated HF hospitalized for other reasons.

Objective:

To identify causes and predictors of in-hospital mortality in patients hospitalized for acute decompensated HF (ADHF), compared to those with HF and admitted to the hospital for non-HF related causes (NDHF).

Methods:

Historical cohort of patients hospitalized in a public tertiary hospital in Brazil with a diagnosis of HF identified by the Charlson Comorbidity Index (CCI).

Results:

A total of 2056 patients hospitalized between January 2009 and December 2010 (51% men, median age of 71 years, length of stay of 15 days) were evaluated. There were 17.6% of deaths during hospitalization, of which 58.4% were non-cardiovascular (63.6% NDHF vs 47.4% ADHF, p = 0.004). Infectious causes were responsible for most of the deaths and only 21.6% of the deaths were attributed to HF. The independent predictors of in-hospital mortality were similar between the groups and included: age, length of stay, elevated potassium, clinical comorbidities, and CCI. Renal insufficiency was the most relevant predictor in both groups.

Conclusion:

Patients hospitalized with HF have high in-hospital mortality, regardless of the primary reason for hospitalization. Few deaths are directly attributed to HF; Age, renal function and levels of serum potassium, length of stay, comorbid burden and CCI were independent predictors of in-hospital death in a Brazilian tertiary hospital.

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Viewpoint

Cardiogeriatric, the Future's Cardiology?

Roberto Alexandre Franken et al. Ronaldo Fernandes Rosa

The aging process and survival of living organisms vary among animal and plant species as well as within the same species. The aging process is partially determined by genetic factors and mutations that can prolong the life of many organisms, including worms, flies, and mice, by delaying this process. Considering that most biological processes are conserved through evolution, genes that are identical or similar to those found in other species can regulate factors associated with survival in humans.

In addition to genetic factors, environmental factors, lifestyle, and disease are also associated with longevity.

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Artigo Original

Prognostic value of chronotropic incompetence in elderly patients undergoing exercise echocardiography

Juliana Silva Santana et al. José Carlos Sizino Franco Filho Antônio Arestides de Sá Neto Enaldo Vieira de Melo … Nathalie Oliveira de Santana Ana Terra Fonseca Barreto Luiza Dantas Melo José Augusto Barreto Filho Antônio Carlos Sobral Sousa Joselina Luzia Menezes Oliveira

BACKGROUND: Chronotropic incompetence (CI), defined as failure to achieve less than 80% of age-expected heart rate, is a predictor of mortality and adverse cardiovascular events and may confer a worse prognosis in elderly diabetic individuals. OBJECTIVE: To evaluate the prognostic value of chronotropic incompetence (CI) in elderly diabetic patients considering endpoints with acute myocardial infarction (AMI), cerebrovascular disease (CVD) and overall mortality and compare clinical and echocardiographic characteristics between patients with and without CI. METHOD: A total of 298 elderly diabetic patients undergoing exercise echocardiography (EE) were studied from January 2001 to December 2010. Of these, 109 were chronotropic incompetent (group 1) and were compared with the chronotropic competent ones (group 2) regarding the occurrence of cardiovascular events, clinical and echocardiographic characteristics. RESULTS: Chronotropic incompetents patients showed a higher frequency of cerebrovascular disease (9.2% vs. 3.2, p = 0.027) and higher mortality was observed in those who had cerebrovascular disease or acute myocardial infarction. The presence of typical angina and dyspnea prior to the performance of EE and male gender were more frequent in group 1. Rest and exercise left ventricular wall motion score index, rate of left ventricle mass and left atrium diameter were higher in chronotropic incompetent individuals. CONCLUSION: Chronotropic incompetence was independently associated with the occurrence of cerebrovascular disease in elderly diabetic individuals.

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Review Article

Heart failure with preserved ejection fraction: fighting misconceptions for a new approach

Ricardo Fontes-Carvalho et al. Adelino Leite-Moreira

Over the last decades, heart failure with preserved ejection fraction (HFpEF) has received less attention by the medical and scientific communities, which led to the emergence of a number of misconceptions concerning its characteristics, diagnostic and therapeutic approach. In recent years, new studies have changed the concepts traditionally associated with HFpEF, contributing to a new view towards this disease. This review is intended to discuss the latest evidence on HFpEF and to fight the main misconceptions associated with it in order to improve its diagnostic and therapeutic approach. Today we have several data showing that HFpEF is a condition that requires a different clinical approach from that used in systolic heart failure (SHF). HFpEF is no longer seen as a “benign” disease because it is associated with a poor prognosis and high prevalence. Its pathophysiology is complex and not fully clarified. In addition to diastolic dysfunction, we now know that other cardiac and extracardiac factors are also involved in its onset and progression. Using recent consensus guidelines we have objective criteria for its diagnosis, especially by using the new echocardiographic parameters for assessing diastolic function, including the E/e’ ratio obtained by tissue Doppler. Finally, treatment of HFpEF remains unknown, because no therapeutic strategy has been shown to improve HFpEF prognosis. Thus, in this review we will also discuss the potentially new therapeutic targets for HFpEF.

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The Challenges of Heart Failure Yesterday, Today and Tomorrow and the 20 Years of DEIC

Causes and Predictors of In-Hospital Mortality in Patients Admitted with or for Heart Failure at a Tertiary Hospital in Brazil

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

Cardiogeriatric, the Future's Cardiology?

Prognostic value of chronotropic incompetence in elderly patients undergoing exercise echocardiography

Heart failure with preserved ejection fraction: fighting misconceptions for a new approach

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