Fragilidad y características clínicas en pacientes muy ancianos con falla cardiaca aguda

ilustraciones, gráficas

Autores:
Castañeda Camacho, Héctor Andrés
Tipo de recurso:
Fecha de publicación:
2022
Institución:
Universidad Nacional de Colombia
Repositorio:
Universidad Nacional de Colombia
Idioma:
spa
OAI Identifier:
oai:repositorio.unal.edu.co:unal/82595
Acceso en línea:
https://repositorio.unal.edu.co/handle/unal/82595
https://repositorio.unal.edu.co/
Palabra clave:
610 - Medicina y salud
Heart - diseases
Aged - Diseases
Enfermedades cardiacas
Enfermedades de los ancianos
Anciano
Falla cardiaca aguda
Fragilidad
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openAccess
License
Atribución-NoComercial-SinDerivadas 4.0 Internacional
id UNACIONAL2_57ae58134fa083bf157866374a0dd2e8
oai_identifier_str oai:repositorio.unal.edu.co:unal/82595
network_acronym_str UNACIONAL2
network_name_str Universidad Nacional de Colombia
repository_id_str
dc.title.spa.fl_str_mv Fragilidad y características clínicas en pacientes muy ancianos con falla cardiaca aguda
dc.title.translated.eng.fl_str_mv Frailty and clinical features in very elderly patients with acute heart failure
title Fragilidad y características clínicas en pacientes muy ancianos con falla cardiaca aguda
spellingShingle Fragilidad y características clínicas en pacientes muy ancianos con falla cardiaca aguda
610 - Medicina y salud
Heart - diseases
Aged - Diseases
Enfermedades cardiacas
Enfermedades de los ancianos
Anciano
Falla cardiaca aguda
Fragilidad
title_short Fragilidad y características clínicas en pacientes muy ancianos con falla cardiaca aguda
title_full Fragilidad y características clínicas en pacientes muy ancianos con falla cardiaca aguda
title_fullStr Fragilidad y características clínicas en pacientes muy ancianos con falla cardiaca aguda
title_full_unstemmed Fragilidad y características clínicas en pacientes muy ancianos con falla cardiaca aguda
title_sort Fragilidad y características clínicas en pacientes muy ancianos con falla cardiaca aguda
dc.creator.fl_str_mv Castañeda Camacho, Héctor Andrés
dc.contributor.advisor.none.fl_str_mv López Ramírez, Jorge Hernán
dc.contributor.author.none.fl_str_mv Castañeda Camacho, Héctor Andrés
dc.subject.ddc.spa.fl_str_mv 610 - Medicina y salud
topic 610 - Medicina y salud
Heart - diseases
Aged - Diseases
Enfermedades cardiacas
Enfermedades de los ancianos
Anciano
Falla cardiaca aguda
Fragilidad
dc.subject.lemb.eng.fl_str_mv Heart - diseases
Aged - Diseases
dc.subject.lemb.spa.fl_str_mv Enfermedades cardiacas
Enfermedades de los ancianos
dc.subject.proposal.spa.fl_str_mv Anciano
Falla cardiaca aguda
Fragilidad
description ilustraciones, gráficas
publishDate 2022
dc.date.accessioned.none.fl_str_mv 2022-11-01T15:09:11Z
dc.date.available.none.fl_str_mv 2022-11-01T15:09:11Z
dc.date.issued.none.fl_str_mv 2022-10-05
dc.type.spa.fl_str_mv Trabajo de grado - Especialidad Médica
dc.type.driver.spa.fl_str_mv info:eu-repo/semantics/masterThesis
dc.type.version.spa.fl_str_mv info:eu-repo/semantics/acceptedVersion
dc.type.content.spa.fl_str_mv Text
dc.type.redcol.spa.fl_str_mv http://purl.org/redcol/resource_type/TM
status_str acceptedVersion
dc.identifier.uri.none.fl_str_mv https://repositorio.unal.edu.co/handle/unal/82595
dc.identifier.instname.spa.fl_str_mv Universidad Nacional de Colombia
dc.identifier.reponame.spa.fl_str_mv Repositorio Institucional Universidad Nacional de Colombia
dc.identifier.repourl.spa.fl_str_mv https://repositorio.unal.edu.co/
url https://repositorio.unal.edu.co/handle/unal/82595
https://repositorio.unal.edu.co/
identifier_str_mv Universidad Nacional de Colombia
Repositorio Institucional Universidad Nacional de Colombia
dc.language.iso.spa.fl_str_mv spa
language spa
dc.relation.indexed.spa.fl_str_mv RedCol
LaReferencia
dc.relation.references.spa.fl_str_mv 1. Metra M, Cotter G, El-Khorazaty J, Davison BA, Milo O, Carubelli V, et al. Acute heart failure in the elderly: Differences in clinical characteristics, outcomes, and prognostic factors in the Veritas study. J Card Fail [Internet]. 2015;21(3):179–88. Available from: http://dx.doi.org/10.1016/j.cardfail.2014.12.012
2. Metra M, Teerlink JR. Heart failure. Lancet [Internet]. 2017;390(10106):1981–95. Available from: http://dx.doi.org/10.1016/S0140-6736(17)31071-1
3. Calvachi Prieto P, Almánzar JS, Vega MP, Cárdenas YR, Gómez M, Celis E, et al. Clinical characteristics of acute heart failure patients according to left ventricular function. Rev Colomb Cardiol. 2018;25(1):7–12.
4. Beltrami M, Milli M, Fumagalli C. Frailty, sarcopenia and cachexia in heart failure patients: Different clinical entities of the same painting. World J Cardiol. 2021;13(1):1–10.
5. Arango DC, Peláez E. Envejecimiento poblacional en el siglo xxi: Oportunidades, retos y preocupaciones. Salud Uninorte. 2012;28(2):335–48.
6. Díaz DM, Ochoa A, Corzo MA, Sanabria MC, Figueroa CL. Variables associated with frailty in a hospital population in Colombia. Geriatr Gerontol Aging. 2020;14(2):114–9.
7. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.
8. Katsanos S, Bakosis G, Frogudaki A. Acute heart failure syndrome in the elderly. Contin Cardiol Educ. 2017;3(3):93–9.
9. Kurmani S, Squire I. Acute Heart Failure: Definition, Classification and Epidemiology. Curr Heart Fail Rep. 2017;14(5):385–92.
10. Farmakis D, Parissis J, Lekakis J, Filippatos G. Acute Heart Failure: Epidemiology, Risk Factors, and Prevention. Rev Española Cardiol (English Ed. 2015;68(3):245–8.
11. Metra M, Cotter G, El-Khorazaty J, Davison BA, Milo O, Carubelli V, et al. Acute heart failure in the elderly: Differences in clinical characteristics, outcomes, and prognostic factors in the Veritas study. J Card Fail [Internet]. 2015;21(3):179–88. Available from: http://dx.doi.org/10.1016/j.cardfail.2014.12.012
12. Gómez-Mesa JE, Saldarriaga CI, Echeverría LE, Luna P. Colombian heart failure registry (RECOLFACA): methodology and preliminary data. Rev Colomb Cardiol. 2021;28(3):217–30.
13. Gustavo Piñar Sancho DCP. CUERPO EDITORIAL Heart failure in the elderly. Rev Medica Sinerg. 2020;5(9):10.
14. Teixeira A, Arrigo M, Tolppanen H, Gayat E, Laribi S, Metra M, et al. Management of acute heart failure in elderly patients. Arch Cardiovasc Dis [Internet]. 2016;109(6–7):422–30. Available from: http://dx.doi.org/10.1016/j.acvd.2016.02.002
15. Lindenfeld JA, O’Connor CM. Heart Failure in Women. JACC Hear Fail. 2019;7(3):274–5
16. Chivite D, Formiga F, Pujol R. La insuficiencia cardíaca en el paciente anciano. Vol. 211, Revista Clinica Espanola. 2011. p. 26–35.
17. Uchmanowicz I, Nessler J, Gobbens R, Gackowski A, Kurpas D, Straburzynska-Migaj E, et al. Coexisting Frailty With Heart Failure. Front Physiol. 2019;10(July).
18. Llopis García G, Munk Sánchez S, García Briñón MÁ, Fernández Alonso C, González Del Castillo J, Martín-Sánchez FJ. El efecto de la fragilidad física en el pronóstico a largo plazo en los pacientes mayores con insuficiencia cardiaca aguda dados de alta desde un servicio de urgencias. Emergencias. 2019;31(6):413–6
19. Martín-Sánchez FJ, Rodríguez-Adrada E, Mueller C, Vidán MT, Christ M, Frank Peacock W, et al. The Effect of Frailty on 30-day Mortality Risk in Older Patients With Acute Heart Failure Attended in the Emergency Department. Acad Emerg Med. 2017;24(3):298–307.
20. Martín-Sánchez FJ, Rodríguez-Adrada E, Vidan MT, Llopis García G, González del Castillo J, Rizzi MA, et al. Impact of Frailty and Disability on 30-Day Mortality in Older Patients With Acute Heart Failure. Am J Cardiol. 2017;120(7):1151–7.
21. Vidán AT, Sánchez E, Fernández-Avilés F, Serra-Rexach JA, Ortiz J, Bueno H. FRAIL-HF, a study to evaluate the clinical complexity of heart failure in nondependent older patients: Rationale, methods and baseline characteristics. Clin Cardiol. 2014;37(12):725–32.
22. Pandey A, Kitzman D, Reeves G. Frailty Is Intertwined With Heart Failure: Mechanisms, Prevalence, Prognosis, Assessment, and Management. JACC Hear Fail [Internet]. 2019;7(12):1001–11. Available from: https://doi.org/10.1016/j.jchf.2019.10.005
23. Costa D, Aladio M, Girado CA, Pérez de la Hoz R, Sara Berensztein C. Frailty is independently associated with 1-year mortality after hospitalization for acute heart failure. IJC Hear Vasc. 2018;21(2018):103–6.
24. TANAKA S, KAMIYA K, HAMAZAKI N, MATSUZAWA R, NOZAKI K, MAEKAWA EMI, et al. Incremental Value of Objective Frailty Assessment to Predict Mortality in Elderly Patients Hospitalized for Heart Failure. J Card Fail [Internet]. 2018;24(11):723–32. Available from: https://doi.org/10.1016/j.cardfail.2018.06.006
25. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: Evidence for a phenotype. Journals Gerontol - Ser A Biol Sci Med Sci. 2001;56(3):146–57.
26. Gómez Montes JF, Curcio Borrero CL HGF en ancianos, Colombianos. COLOMBIANOS. Rev Médica Sánitas 2012;15(4)8-16. 2012;15(4):8–16.
27. Samper-Ternent R, Reyes-Ortiz C, Ottenbacher KJ, Cano CA. Frailty and sarcopenia in Bogotá: results from the SABE Bogotá Study. Aging Clin Exp Res. 2017;29(2):265–72.
28. Theou O, Brothers TD, Mitnitski A, Rockwood K. Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality. J Am Geriatr Soc. 2013;61(9):1537–51.
29. Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, et al. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol. 2014;63(8):747–62.
30. Martín-Sánchez FJ, Christ M, Miró Ò, Peacock WF, McMurray JJ, Bueno H, et al. Practical approach on frail older patients attended for acute heart failure. Int J Cardiol [Internet]. 2016;222(2016):62–71. Available from: http://dx.doi.org/10.1016/j.ijcard.2016.07.151
31. Ramírez Ramírez JU, Cadena Sanabria MO, Ochoa ME. Aplicación de la Escala de fragilidad de Edmonton en población colombiana. Comparación con los criterios de Fried. Rev Esp Geriatr Gerontol. 2017;52(6):322–5.
32. Tello-Rodríguez T, Varela-Pinedo L. Frailty in older adults: Detection, community-based intervention, and decision-making in the management of chronic illnesses. Rev Peru Med Exp Salud Publica. 2016;33(2):328–34.
33. Sze S, Zhang J, Pellicori P, Morgan D, Hoye A, Clark AL. Prognostic value of simple frailty and malnutrition screening tools in patients with acute heart failure due to left ventricular systolic dysfunction. Clin Res Cardiol. 2017;106(7):533–41.
34. Sze S, Pellicori P, Zhang J, Weston J, Clark AL. Identification of Frailty in Chronic Heart Failure. JACC Hear Fail. 2019;7(4):291–302.
35. Katsanos S, Bistola V, Parissis JT. Acute Heart Failure Syndromes in the Elderly: The European Perspective. Heart Fail Clin. 2015;11(4):637–45.
36. Zhou SL, Zhang J, Song TT, Li X, Wang HX. Diagnostic accuracy of natriuretic peptides for acute heart failure: A review. Eur Rev Med Pharmacol Sci. 2018;22(8):2415–20.
37. Long B, Koyfman A, Gottlieb M. Diagnosis of Acute Heart Failure in the Emergency Department: An Evidence-Based Review. West J Emerg Med. 2019;20(6):875–84.
38. Gök G, Karadağ M, Sinan ÜY, Zoghi M. A New Risk Score to Predict In-Hospital Mortality in Elderly Patients With Acute Heart Failure: On Behalf of the Journey HF-TR Study Investigators. Angiology. 2020;71(10):948–54.
39. Jia Q, Wang YR, He P, Huang XL, Yan W, Mu Y, et al. Prediction model of in-hospital mortality in elderly patients with acute heart failure based on retrospective study. J Geriatr Cardiol. 2017;14(11):669–78.
40. Duflos C, Troude P, Strainchamps D, Ségouin C, Logeart D, Mercier G. Hospitalization for acute heart failure: the in-hospital care pathway predicts one-year readmission. Sci Rep. 2020;10(1):1–8.
41. Tersalvi G, Gasperetti A, Schiavone M, Dauw J, Gobbi C, Denora M, et al. Acute heart failure in elderly patients: A review of invasive and non-invasive management. J Geriatr Cardiol. 2021;18(7):560–76.
42. Orso F, Pratesi A, Herbst A, Baroncini AC, Bacci F, Ciuti G, et al. Acute heart failure in the elderly: Setting related differences in clinical features and management. J Geriatr Cardiol. 2021;18(6):407–15.
43. McIlvennan CK, Allen LA. Palliative care in patients with heart failure. BMJ. 2016;353:1–13.
44. Araya PD, Galleguillos FA. Ageísmo Como Fenómeno Sociocultural Invisible Mayores. 2021;27(1):127–35.
45. Martín-Sánchez FJ, Rodríguez-Adrada E, Llorens P, Formiga F. Mensajes clave para la atención inicial del anciano con insuficiencia cardiaca aguda. Rev Esp Geriatr Gerontol [Internet]. 2015;50(4):185–94. Available from: http://dx.doi.org/10.1016/j.regg.2015.02.005
46. Ng KT, Yap JLL. Continuous infusion vs. intermittent bolus injection of furosemide in acute decompensated heart failure: systematic review and meta-analysis of randomised controlled trials. Anaesthesia. 2018;73(2):238–47.
47. Albert Schweitzer Hospital, Lambarene, Gabon, and Institute of Tropical Medicine, University of Tübingen, Tübingen G. 需要引用的霍奇金第二肿瘤new England Journal. N Engl J Med. 2011;365:687–96.
48. Frea S, Pidello S, Volpe A, Canavosio FG, Galluzzo A, Bovolo V, et al. Diuretic treatment in high-risk acute decompensation of advanced chronic heart failure—bolus intermittent vs. continuous infusion of furosemide: a randomized controlled trial. Clin Res Cardiol [Internet]. 2020;109(4):417–25. Available from: https://doi.org/10.1007/s00392-019-01521-y
49. Herrero-Puente P, Jacob J, Martín-Sánchez FJ, Vázquez-Álvarez J, Martínez-Camblor P, Miró Ò, et al. Influence of Intravenous Nitrate Treatment on Early Mortality among Patients with Acute Heart Failure. NITRO-EAHFE Study. Rev Esp Cardiol. 2015;68(11):959–67.
50. Llorens P, Miró Ò, Martín Sánchez FJ, Herrero Puente P, Jacob Rodríguez J, Gil V, et al. Manejo de la insuficiencia cardiaca aguda en los servicios de urgencias, emergencias y unidades adscritas. Documento de consenso del Grupo de Insuficiencia Cardiaca Aguda de la Sociedad Española de Medicina de Urgencias y Emergencias (ICA-SEMES). Emergencias. 2011;23(2):119–39.
51. Holt DB, Pang PS. Vasodilator Therapies in the Treatment of Acute Heart Failure. Curr Heart Fail Rep. 2019;16(1):32–7.
52. Kamran H, Tang WHW. Medical management of acute heart failure. Fac Rev. 2021 Dec 6;10:82. doi: 10.12703/r/10-82. PMID: 35028647; PMCID: PMC872564
53. Mebazaa A, Tolppanen H, Mueller C, Lassus J, DiSomma S, Baksyte G, et al. Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance. Intensive Care Med. 2016;42(2):147–63.
54. Butler J, Anstrom KJ, Felker GM, Givertz MM, Kalogeropoulos AP, Konstam MA, et al. Efficacy and safety of spironolactone in acute heart failure: The ATHENA-HF randomized clinical trial. JAMA Cardiol. 2017;2(9):950–8.
55. Tomasoni D, Adamo M, Anker MS, von Haehling S, Coats AJS, Metra M. Heart failure in the last year: progress and perspective. ESC Hear Fail. 2020;7(6):3505–30.
56. Mohyeldin M, Tavares LB, Boorenie M, Abureesh D, Ejaz S, Durrani L, et al. Efficacy of Sacubitril/Valsartan in the Setting of Acute Heart Failure: A Systematic Review. Cureus. 2021;13(10).
57. Velazquez EJ, Morrow DA, DeVore AD, Duffy CI, Ambrosy AP, McCague K, et al. Angiotensin–Neprilysin Inhibition in Acute Decompensated Heart Failure. N Engl J Med. 2019;380(6):539–48.
58. Wachter R, Senni M, Belohlavek J, Straburzynska-Migaj E, Witte KK, Kobalava Z, et al. Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge: primary results of the randomised TRANSITION study. Eur J Heart Fail. 2019;21(8):998–1007.
59. Pablo A. Olavegogeascoechea. De la evidencia a la práctica en la insuficiencia cardíaca. Rev Argentina Med. 2017;5(2):132–3.
60. Solomon SD, McMurray JJV, Anand IS, Ge J, Lam CSP, Maggioni AP, et al. Angiotensin–Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction. N Engl J Med. 2019;381(17):1609–20.
61. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Vol. 145, Circulation. 2022. 895–1032 p.
62. Damman K, Beusekamp JC, Boorsma EM, Swart HP, Smilde TDJ, Elvan A, et al. Randomized, double-blind, placebo-controlled, multicentre pilot study on the effects of empagliflozin on clinical outcomes in patients with acute decompensated heart failure (EMPA-RESPONSE-AHF). Eur J Heart Fail. 2020;22(4):713–22.
63. Bhatt DL, Szarek M, Steg PG, Cannon CP, Leiter LA, McGuire DK, et al. Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure. N Engl J Med. 2021;384(2):117–28.
64. Pandey A, Kitzman D, Whellan DJ, Duncan PW, Mentz RJ, Pastva AM, et al. Frailty Among Older Decompensated Heart Failure Patients: Prevalence, Association With Patient-Centered Outcomes, and Efficient Detection Methods. JACC Hear Fail. 2019;7(12):1079–88.
65. Lemus Barrios GA, Morales Benavidez DC, López Salazar AM, Henao V, González-Robledo G. Assessment of frailty in cardiovascular disease: A necessary challenge. Rev Colomb Cardiol [Internet]. 2020;27(4):283–93. Available from: https://doi.org/10.1016/j.rccar.2019.12.015
66. Moorhouse P, Rockwood K. Frailty and its quantitative clinical evaluation. J R Coll Physicians Edinb. 2013;42(4):333–40.
67. Theou O, Campbell S, Malone ML, Rockwood K. Older Adults in the Emergency Department with Frailty. Clin Geriatr Med. 2018;34(3):369–86.
68. Matsue Y, Kamiya K, Saito H, Saito K, Ogasahara Y, Maekawa E, et al. Prevalence and prognostic impact of the coexistence of multiple frailty domains in elderly patients with heart failure: the FRAGILE-HF cohort study. Eur J Heart Fail. 2020;22(11):2112–9.
69. Díaz-Toro F, Nazzal Nazal C, Verdejo H, Rossel V, Castro P, Larrea R, et al. Factores asociados a fragilidad en pacientes hospitalizados con insuficiencia cardiaca descompensada. Rev Med Chil. 2017;145(2):164–71.
70. Sloane PD, Cesari M. Research on Frailty: Continued Progress, Continued Challenges. J Am Med Dir Assoc [Internet]. 2018;19(4):279–81. Available from: https://doi.org/10.1016/j.jamda.2018.01.003
71. Liang YD, Zhang YN, Li YM, Chen YH, Xu JY, Liu M, et al. Identification of frailty and its risk factors in elderly hospitalized patients from different wards: A cross-sectional study in China. Clin Interv Aging. 2019;14:2249–59.
72. O’Caoimh R, Costello M, Small C, Spooner L, Flannery A, O’Reilly L, et al. Comparison of frailty screening instruments in the emergency department. Int J Environ Res Public Health. 2019;16(19):1–13.
73. Wallis SJ, Wall J, Biram RWS, Romero-Ortuno R. Association of the clinical frailty scale with hospital outcomes. Qjm. 2015;108(12):943–9.
74. Kanenawa K, Isotani A, Yamaji K, Nakamura M, Tanaka Y, Hirose-Inui K, et al. The impact of frailty according to Clinical Frailty Scale on clinical outcome in patients with heart failure. ESC Hear Fail. 2021;8(2):1552–61.
75. Strandberg TE, Nieminen T. Future Perspectives on the Role of Frailty in Cardiovascular Diseases. Vol. 1216, Advances in Experimental Medicine and Biology. 2020. 149–152 p.
76. Yaku H, Kato T, Morimoto T, Inuzuka Y, Tamaki Y, Ozasa N, et al. Risk factors and clinical outcomes of functional decline during hospitalisation in very old patients with acute decompensated heart failure: An observational study. BMJ Open. 2020;10(2).
77. Szanton SL, Seplaki CL, Thorpe RJ, Allen JK, Fried LP. Socioeconomic status is associated with frailty: The Women’s Health and Aging Studies. J Epidemiol Community Health. 2010;64(1):63–7.
78. Wang J, Hulme C. Frailty and socioeconomic status: A systematic review. J Public health Res. 2021;10(3):553–60.
79. Aimo A, Barison A, Mammini C, Emdin M. The Barthel Index in elderly acute heart failure patients. Frailty matters. Int J Cardiol [Internet]. 2018;254:240–1. Available from: https://doi.org/10.1016/j.ijcard.2017.11.010
80. Chivite D, Formiga F, Corbella X, Conde-Martel A, Aramburu Ó, Carrera M, et al. Basal functional status predicts one-year mortality after a heart failure hospitalization in elderly patients — The RICA prospective study. Int J Cardiol [Internet]. 2018;254:182–8. Available from: https://doi.org/10.1016/j.ijcard.2017.10.104
81. Formiga F, Chivite D, Conde A, Ruiz-Laiglesia F, Franco ÁG, Bocanegra CP, et al. Basal functional status predicts three-month mortality after a heart failure hospitalization in elderly patients - The prospective RICA study. Int J Cardiol [Internet]. 2014;172(1):127–31.
82. Claret PG, Stiell IG, Yan JW, Clement CM, Rowe BH, Calder LA, et al. Characteristics and outcomes for acute heart failure in elderly patients presenting to the ED. Am J Emerg Med [Internet]. 2016;34(11):2159–66.
83. Wu Y, Zhu W, He X, Xue R, Liang W, Wei F, et al. Influence of polypharmacy on patients with heart failure with preserved ejection fraction: A retrospective analysis on adverse outcomes in the TOPCAT trial. Br J Gen Pract. 2021;71(702):E62–70.
84. Beezer J, Al Hatrushi M, Husband A, Kurdi A, Forsyth P. Polypharmacy definition and prevalence in heart failure: a systematic review. Heart Fail Rev [Internet]. 2022;27(2):465–92.
85. Unlu O, Levitan EB, Reshetnyak E, Kneifati-Hayek J, Diaz I, Archambault A, et al. Polypharmacy in Older Adults Hospitalized for Heart Failure. Circ Hear Fail. 2020;13(11):E006977.
86. Mastromarino V, Casenghi M, Testa M, Gabriele E, Coluccia R, Rubattu S, et al. Polypharmacy in heart failure patients. Curr Heart Fail Rep. 2014;11(2):212–9.
87. Reed BN, Rodgers JE, Sueta CA. Polypharmacy in Heart Failure. Drugs to Use and Avoid. Heart Fail Clin [Internet]. 2014;10(4):577–90.
88. Pazan F, Wehling M. Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences. Eur Geriatr Med [Internet]. 2021;12(3):443–52.
89. Rao VN, Fudim M, Savarese G, Butler J. Polypharmacy in Heart Failure with Reduced Ejection Fraction: Progress, Not Problem. Am J Med [Internet]. 2021;134(9):1068–70.
90. Veenis JF, Brunner-La Rocca HP, Linssen GCM, Geerlings PR, Van Gent MWF, Aksoy I, et al. Age differences in contemporary treatment of patients with chronic heart failure and reduced ejection fraction. Eur J Prev Cardiol. 2019;26(13):1399–407.
91. Milinković I, Polovina M, Coats AJ, Rosano GM, Seferović PM. Medical Treatment of Heart Failure with Reduced Ejection Fraction in the Elderly. Card Fail Rev. 2022;8.
92. Younis A, Mulla W, Goldkorn R, Klempfner R, Peled Y, Arad M, et al. Differences in Mortality of New-Onset (De-Novo) Acute Heart Failure Versus Acute Decompensated Chronic Heart Failure. Am J Cardiol [Internet]. 2019;124(4):554–9.
93. Formiga F, Moreno-Gonzalez R, Chivite D, Franco J, Montero A, Corbella X. High comorbidity, measured by the Charlson Comorbidity Index, associates with higher 1-year mortality risks in elderly patients experiencing a first acute heart failure hospitalization. Aging Clin Exp Res [Internet]. 2018;30(8):927–33.
94. Franco Jonathan , Formiga Francesc , Chivite David,Corbella Javier, Robert Jordi, Vidaller Antonio, Charte Angel. Insuficiencia cardiaca aguda en el anciano:Características clínicas y mortalidad según la fracción de eyección ventricular izquierda.Rev Colomb Cardiol. 2017;24(3):250-254
95. Kim V, Aaron SD. What is a COPD exacerbation? Current definitions, pitfalls, challenges and opportunities for improvement. Eur Respir J [Internet]. 2018;52(5). Available from: http://dx.doi.org/10.1183/13993003.01261-2018
96. Jacob J, Tost J, Miró Ò, Herrero P, Martín-Sánchez FJ, Llorens P. Impact of chronic obstructive pulmonary disease on clinical course after an episode of acute heart failure. EAHFE–COPD study. Int J Cardiol [Internet]. 2017;227:450–6.
97. Van Den Berge JC, Van Vark LC, Postmus D, Utens EMWJ, Hillege HL, Boersma E, et al. Determinants of quality of life in acute heart failure patients with and without comorbidities: a prospective, observational study. Eur J Cardiovasc Nurs. 2022;21(3):205–12.
98. Gulea C, Zakeri R, Kallis C, Quint JK. Impact of COPD and asthma on in- ­ hospital mortality and management of patients with heart failure in England and Wales : an observational analysis. 2022;1–10.
99. Sung SH, Wang TJ, Cheng HM, Yu WC, Guo CY, Chiang CE, et al. Clinical Characteristics and Outcomes in the Very Elderly Patients Hospitalized for Acute Heart Failure: Importance of Pharmacologic Guideline Adherence. Sci Rep [Internet]. 2018;8(1):4–11.
100. Arrigo M, Jessup M, Mullens W, Reza N, Shah AM, Sliwa K, et al. Acute heart failure. Nat Rev Dis Prim [Internet]. 2020;6(1). Available from: http://dx.doi.org/10.1038/s41572-020-0151-7
101. Alvarado CS, Avila RY-, Marron-veria E, Málaga-zenteno J, Adamkiewicz T V, Hematología S De, et al. Avances en el diagnóstico y tratamiento de deficiencia de hierro y anemia ferropenica Advances in the diagnosis and treatment of iron deficiency and iron deficiency anemia. 2022;83(1):65–9.
102. Chopra VK, Anker SD. Anaemia, iron deficiency and heart failure in 2020: facts and numbers. ESC Hear Fail. 2020;7(5):2007–11.
103. Loncar G, Obradovic D, Thiele H, von Haehling S, Lainscak M. Iron deficiency in heart failure. ESC Hear Fail. 2021;8(4):2368–79.
104. Rizzo C, Carbonara R, Ruggieri R, Passantino A, Scrutinio D. Iron Deficiency: A New Target for Patients With Heart Failure. Front Cardiovasc Med. 2021;8(August).
105. Cunha GJL, Rocha BML, Menezes Falcão L. Iron deficiency in chronic and acute heart failure: A contemporary review on intertwined conditions. Eur J Intern Med. 2018;52(April):1–7.
106. Tee SL, Sindone A, Roger S, Atherton J, Amerena J, D’Emden M, et al. Hyponatraemia in heart failure. Intern Med J. 2020;50(6):659–66.
107. Matsue Y, Yoshioka K, Suzuki M, Torii S, Yamaguchi S, Fukamizu S, et al. Prognostic importance of sodium level trajectory in acute heart failure. Heart Vessels. 2017;32(12):1498–505.
108. Liamis G, Filippatos TD, Elisaf MS. Thiazide-associated hyponatremia in the elderly: What the clinician needs to know. J Geriatr Cardiol. 2016;13(2):175–82.
109. Carubelli V, Metra M, Lombardi C, Bettari L, Bugatti S, Lazzarini V, et al. Renal dysfunction in acute heart failure: Epidemiology, mechanisms and assessment. Heart Fail Rev. 2012;17(2):271–82.
110. McCullough PA, Jefferies JL. Novel markers and therapies for patients with acute heart failure and renal dysfunction. Am J Med [Internet]. 2015;128(3):312.e1-312.e22. Available from: http://dx.doi.org/10.1016/j.amjmed.2014.10.035
111. Matsue Y, Van Der Meer P, Damman K, Metra M, O’Connor CM, Ponikowski P, et al. Blood urea nitrogen-to-creatinine ratio in the general population and in patients with acute heart failure. Heart. 2017;103(6):407–13.
112. Pourafkari L, Tajlil A, Nader ND. Biomarkers in diagnosing and treatment of acute heart failure. Biomark Med. 2019;13(14):1235–49.
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dc.rights.license.spa.fl_str_mv Atribución-NoComercial-SinDerivadas 4.0 Internacional
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dc.publisher.branch.spa.fl_str_mv Universidad Nacional de Colombia - Sede Bogotá
institution Universidad Nacional de Colombia
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spelling Atribución-NoComercial-SinDerivadas 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2López Ramírez, Jorge Hernánf0c378e36ea73dfa7ff2ed62b81a2c6eCastañeda Camacho, Héctor Andrés47429b5e0fd2d1ca69a250d37a8d520d2022-11-01T15:09:11Z2022-11-01T15:09:11Z2022-10-05https://repositorio.unal.edu.co/handle/unal/82595Universidad Nacional de ColombiaRepositorio Institucional Universidad Nacional de Colombiahttps://repositorio.unal.edu.co/ilustraciones, gráficasFragilidad y características clínicas en pacientes muy ancianos con falla cardiaca aguda Introducción: La principal causa de hospitalización en ancianos es la falla cardiaca aguda, con alta morbimortalidad, principalmente cuando coexiste con la fragilidad, cuya prevalencia se encuentra hasta en un 70%. El objetivo del presente estudio fue determinar la prevalencia de este síndrome geriátrico en pacientes muy ancianos hospitalizados por falla cardiaca. Diseño: Estudio descriptivo de corte transversal. Métodos: Se incluyeron pacientes > 80 años hospitalizados con diagnóstico de falla cardiaca durante un periodo de 7 meses. Se tamizó la fragilidad con la escala clínica de fragilidad, considerando frágiles a los pacientes con una CFS > 5. Se evaluaron otros síndromes geriátricos y se realizó una descripción de las características clínicas y sociodemográficas de la población. Resultados: Se analizaron 123 pacientes, el promedio de edad fue 85.31 años ( DE 3.86). La prevalencia de fragilidad fue del 51.2% (IC95% 42% - 60%). Solo 22 % eran independientes en sus actividades básicas, 42.3 % cumplían con la definición de polifarmacia , 35 % tenía una alta carga de comorbilidad y 16.3 % cumplía con la definición de caedor recurrente. Las principales causas de descompensación identificadas fueron la exacerbación de EPOC y las infecciones como celulitis, sepsis abdominal y colecistitis aguda en un 22.8 %, seguido en un 17.07 % por el tromboembolismo pulmonar. Conclusiones: La prevalencia de fragilidad en pacientes muy ancianos con falla cardiaca aguda es elevada, para mitigar los efectos deletéreos de este síndrome geriátrico se deben realizar intervenciones para el control de la multimorbilidad, estado físico y cognitivo, además de ofrecer un manejo médico acorde a las guías y objetivos terapéuticos individualizados y con un seguimiento clínico estrecho. (Texto tomado de la fuente)Frailty and clinical features in very elderly patients with acute heart failure Introduction: The main cause of hospitalization in the elderly is acute heart failure, with high morbidity and mortality, mainly when it coexists with frailty, whose prevalence is up to 70%. The objective of the present study was to determine the prevalence of this geriatric syndrome in very elderly patients hospitalized for heart failure. Design: Descriptive cross-sectional study. Methods: Patients > 80 years hospitalized with a diagnosis of heart failure for a period of 7 months were included. Frailty was screened using the clinical frailty scale, considering frail patients with a CFS > 5. Other geriatric syndromes were evaluated and a description of the clinical and sociodemographic characteristics of the population was made. Results: 123 patients were analyzed; the average age was 85.31 years (SD 3.86). The prevalence of frailty was 51.2% (95% CI 42% - 60%). Only 22% were independent in their basic activities, 42.3% met the definition of polypharmacy, 35% had a high burden of comorbidity, and 16.3% met the definition of recurrent faller. The main causes of decompensation identified were COPD exacerbation and infections such as cellulitis, abdominal sepsis, and acute cholecystitis in 22.8%, followed by pulmonary thromboembolism in 17.07%. Conclusions: The prevalence of frailty in very elderly patients with acute heart failure is high, to mitigate the deleterious effects of this geriatric syndrome, interventions should be carried out to control multimorbidity, physical and cognitive status, in addition to offering appropriate medical management to the guidelines and individualized therapeutic objectives, with a close clinical follow-up.Especialidades MédicasEspecialista en GeriatríaMetodología Diseño del estudio: Estudio de corte transversal Población blanco Adultos mayores de 80 años o más, hospitalizados por falla cardiaca aguda en el Hospital Universitario San Rafael De Tunja, desde el 01 de Julio de 2021 hasta 31 de Enero de 2022. Tamaño de muestra: Muestra a conveniencia no probabilística Criterios de inclusión: Adultos mayores de 80 años o más, hospitalizados por falla cardiaca aguda. Criterios de exclusión: •Pacientes que no deseen firmar consentimiento informado para participar en el estudio •Historias clínicas con información inferior del 60% de los datos requeridos, o que no registren el tamizaje de fragilidad por medio de la escala clínica de fragilidad. •Pacientes duplicados en la base de datos Procedimientos y recolección de la información: Posterior a aprobación del comité de investigación y de ética del Hospital Universitario San Rafael De Tunja, los participantes fueron seleccionados a su ingreso a urgencias o sala general con diagnóstico de falla cardiaca descompensada y edad mayor o igual a 80 años. Previo diligenciamiento del consentimiento informado se estableció encuesta personal con el paciente y familiar para diligenciar contenido y variables correspondientes a la herramienta de recolección de datos, también aprobada por el comité de ética de la institución en mención . Para controlar la calidad de la información extraída, los coinvestigadores fueron entrenados en el diligenciamiento y conocimiento de las diferentes variables de la herramienta de recolección de datos, toda la Información complementaria fue obtenida a partir de la historia clínica sistematizada del Hospital Universitario San Rafael De Tunja accediendo al software Servinte®. La información de las variables obtenidas de la historia clínica y encuesta fue registrada por los investigadores en un formato de recolección físico y en el software Excel V2016. Para controlar la calidad de la información extraída y verificar errores, se realizó doble revisión de los datos diligenciados en el formato físico y el software Excel V2016. Se realizo revisión semanal entre el investigador principal y los demás investigadores del control de inconsistencias, para verificar la correcta digitación de los datos y adecuado diligenciamiento del instrumento de EXCEL.xvii, 83 páginasapplication/pdfspaUniversidad Nacional De ColombiaBogotá - Medicina - Especialidad en GeriatríaFacultad de MedicinaUniversidad Nacional de Colombia - Sede Bogotá610 - Medicina y saludHeart - diseasesAged - DiseasesEnfermedades cardiacasEnfermedades de los ancianosAncianoFalla cardiaca agudaFragilidadFragilidad y características clínicas en pacientes muy ancianos con falla cardiaca agudaFrailty and clinical features in very elderly patients with acute heart failureTrabajo de grado - Especialidad Médicainfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/acceptedVersionTexthttp://purl.org/redcol/resource_type/TMRedColLaReferencia1. Metra M, Cotter G, El-Khorazaty J, Davison BA, Milo O, Carubelli V, et al. Acute heart failure in the elderly: Differences in clinical characteristics, outcomes, and prognostic factors in the Veritas study. J Card Fail [Internet]. 2015;21(3):179–88. Available from: http://dx.doi.org/10.1016/j.cardfail.2014.12.0122. Metra M, Teerlink JR. Heart failure. Lancet [Internet]. 2017;390(10106):1981–95. Available from: http://dx.doi.org/10.1016/S0140-6736(17)31071-13. Calvachi Prieto P, Almánzar JS, Vega MP, Cárdenas YR, Gómez M, Celis E, et al. Clinical characteristics of acute heart failure patients according to left ventricular function. Rev Colomb Cardiol. 2018;25(1):7–12.4. Beltrami M, Milli M, Fumagalli C. Frailty, sarcopenia and cachexia in heart failure patients: Different clinical entities of the same painting. World J Cardiol. 2021;13(1):1–10.5. Arango DC, Peláez E. Envejecimiento poblacional en el siglo xxi: Oportunidades, retos y preocupaciones. Salud Uninorte. 2012;28(2):335–48.6. Díaz DM, Ochoa A, Corzo MA, Sanabria MC, Figueroa CL. Variables associated with frailty in a hospital population in Colombia. Geriatr Gerontol Aging. 2020;14(2):114–9.7. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.8. Katsanos S, Bakosis G, Frogudaki A. Acute heart failure syndrome in the elderly. Contin Cardiol Educ. 2017;3(3):93–9.9. Kurmani S, Squire I. Acute Heart Failure: Definition, Classification and Epidemiology. Curr Heart Fail Rep. 2017;14(5):385–92.10. Farmakis D, Parissis J, Lekakis J, Filippatos G. Acute Heart Failure: Epidemiology, Risk Factors, and Prevention. Rev Española Cardiol (English Ed. 2015;68(3):245–8.11. Metra M, Cotter G, El-Khorazaty J, Davison BA, Milo O, Carubelli V, et al. Acute heart failure in the elderly: Differences in clinical characteristics, outcomes, and prognostic factors in the Veritas study. J Card Fail [Internet]. 2015;21(3):179–88. Available from: http://dx.doi.org/10.1016/j.cardfail.2014.12.01212. Gómez-Mesa JE, Saldarriaga CI, Echeverría LE, Luna P. Colombian heart failure registry (RECOLFACA): methodology and preliminary data. Rev Colomb Cardiol. 2021;28(3):217–30.13. Gustavo Piñar Sancho DCP. CUERPO EDITORIAL Heart failure in the elderly. Rev Medica Sinerg. 2020;5(9):10.14. Teixeira A, Arrigo M, Tolppanen H, Gayat E, Laribi S, Metra M, et al. Management of acute heart failure in elderly patients. Arch Cardiovasc Dis [Internet]. 2016;109(6–7):422–30. Available from: http://dx.doi.org/10.1016/j.acvd.2016.02.00215. Lindenfeld JA, O’Connor CM. Heart Failure in Women. JACC Hear Fail. 2019;7(3):274–516. Chivite D, Formiga F, Pujol R. La insuficiencia cardíaca en el paciente anciano. Vol. 211, Revista Clinica Espanola. 2011. p. 26–35.17. Uchmanowicz I, Nessler J, Gobbens R, Gackowski A, Kurpas D, Straburzynska-Migaj E, et al. Coexisting Frailty With Heart Failure. Front Physiol. 2019;10(July).18. Llopis García G, Munk Sánchez S, García Briñón MÁ, Fernández Alonso C, González Del Castillo J, Martín-Sánchez FJ. El efecto de la fragilidad física en el pronóstico a largo plazo en los pacientes mayores con insuficiencia cardiaca aguda dados de alta desde un servicio de urgencias. Emergencias. 2019;31(6):413–619. Martín-Sánchez FJ, Rodríguez-Adrada E, Mueller C, Vidán MT, Christ M, Frank Peacock W, et al. The Effect of Frailty on 30-day Mortality Risk in Older Patients With Acute Heart Failure Attended in the Emergency Department. Acad Emerg Med. 2017;24(3):298–307.20. Martín-Sánchez FJ, Rodríguez-Adrada E, Vidan MT, Llopis García G, González del Castillo J, Rizzi MA, et al. Impact of Frailty and Disability on 30-Day Mortality in Older Patients With Acute Heart Failure. Am J Cardiol. 2017;120(7):1151–7.21. Vidán AT, Sánchez E, Fernández-Avilés F, Serra-Rexach JA, Ortiz J, Bueno H. FRAIL-HF, a study to evaluate the clinical complexity of heart failure in nondependent older patients: Rationale, methods and baseline characteristics. Clin Cardiol. 2014;37(12):725–32.22. Pandey A, Kitzman D, Reeves G. Frailty Is Intertwined With Heart Failure: Mechanisms, Prevalence, Prognosis, Assessment, and Management. JACC Hear Fail [Internet]. 2019;7(12):1001–11. Available from: https://doi.org/10.1016/j.jchf.2019.10.00523. Costa D, Aladio M, Girado CA, Pérez de la Hoz R, Sara Berensztein C. Frailty is independently associated with 1-year mortality after hospitalization for acute heart failure. IJC Hear Vasc. 2018;21(2018):103–6.24. TANAKA S, KAMIYA K, HAMAZAKI N, MATSUZAWA R, NOZAKI K, MAEKAWA EMI, et al. Incremental Value of Objective Frailty Assessment to Predict Mortality in Elderly Patients Hospitalized for Heart Failure. J Card Fail [Internet]. 2018;24(11):723–32. Available from: https://doi.org/10.1016/j.cardfail.2018.06.00625. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: Evidence for a phenotype. Journals Gerontol - Ser A Biol Sci Med Sci. 2001;56(3):146–57.26. Gómez Montes JF, Curcio Borrero CL HGF en ancianos, Colombianos. COLOMBIANOS. Rev Médica Sánitas 2012;15(4)8-16. 2012;15(4):8–16.27. Samper-Ternent R, Reyes-Ortiz C, Ottenbacher KJ, Cano CA. Frailty and sarcopenia in Bogotá: results from the SABE Bogotá Study. Aging Clin Exp Res. 2017;29(2):265–72.28. Theou O, Brothers TD, Mitnitski A, Rockwood K. Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality. J Am Geriatr Soc. 2013;61(9):1537–51.29. Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, et al. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol. 2014;63(8):747–62.30. Martín-Sánchez FJ, Christ M, Miró Ò, Peacock WF, McMurray JJ, Bueno H, et al. Practical approach on frail older patients attended for acute heart failure. Int J Cardiol [Internet]. 2016;222(2016):62–71. Available from: http://dx.doi.org/10.1016/j.ijcard.2016.07.15131. Ramírez Ramírez JU, Cadena Sanabria MO, Ochoa ME. Aplicación de la Escala de fragilidad de Edmonton en población colombiana. Comparación con los criterios de Fried. Rev Esp Geriatr Gerontol. 2017;52(6):322–5.32. Tello-Rodríguez T, Varela-Pinedo L. Frailty in older adults: Detection, community-based intervention, and decision-making in the management of chronic illnesses. Rev Peru Med Exp Salud Publica. 2016;33(2):328–34.33. Sze S, Zhang J, Pellicori P, Morgan D, Hoye A, Clark AL. Prognostic value of simple frailty and malnutrition screening tools in patients with acute heart failure due to left ventricular systolic dysfunction. Clin Res Cardiol. 2017;106(7):533–41.34. Sze S, Pellicori P, Zhang J, Weston J, Clark AL. Identification of Frailty in Chronic Heart Failure. JACC Hear Fail. 2019;7(4):291–302.35. Katsanos S, Bistola V, Parissis JT. Acute Heart Failure Syndromes in the Elderly: The European Perspective. Heart Fail Clin. 2015;11(4):637–45.36. Zhou SL, Zhang J, Song TT, Li X, Wang HX. Diagnostic accuracy of natriuretic peptides for acute heart failure: A review. Eur Rev Med Pharmacol Sci. 2018;22(8):2415–20.37. Long B, Koyfman A, Gottlieb M. Diagnosis of Acute Heart Failure in the Emergency Department: An Evidence-Based Review. West J Emerg Med. 2019;20(6):875–84.38. Gök G, Karadağ M, Sinan ÜY, Zoghi M. A New Risk Score to Predict In-Hospital Mortality in Elderly Patients With Acute Heart Failure: On Behalf of the Journey HF-TR Study Investigators. Angiology. 2020;71(10):948–54.39. Jia Q, Wang YR, He P, Huang XL, Yan W, Mu Y, et al. Prediction model of in-hospital mortality in elderly patients with acute heart failure based on retrospective study. J Geriatr Cardiol. 2017;14(11):669–78.40. Duflos C, Troude P, Strainchamps D, Ségouin C, Logeart D, Mercier G. Hospitalization for acute heart failure: the in-hospital care pathway predicts one-year readmission. Sci Rep. 2020;10(1):1–8.41. Tersalvi G, Gasperetti A, Schiavone M, Dauw J, Gobbi C, Denora M, et al. Acute heart failure in elderly patients: A review of invasive and non-invasive management. J Geriatr Cardiol. 2021;18(7):560–76.42. Orso F, Pratesi A, Herbst A, Baroncini AC, Bacci F, Ciuti G, et al. Acute heart failure in the elderly: Setting related differences in clinical features and management. J Geriatr Cardiol. 2021;18(6):407–15.43. McIlvennan CK, Allen LA. Palliative care in patients with heart failure. BMJ. 2016;353:1–13.44. Araya PD, Galleguillos FA. Ageísmo Como Fenómeno Sociocultural Invisible Mayores. 2021;27(1):127–35.45. Martín-Sánchez FJ, Rodríguez-Adrada E, Llorens P, Formiga F. Mensajes clave para la atención inicial del anciano con insuficiencia cardiaca aguda. Rev Esp Geriatr Gerontol [Internet]. 2015;50(4):185–94. Available from: http://dx.doi.org/10.1016/j.regg.2015.02.00546. Ng KT, Yap JLL. Continuous infusion vs. intermittent bolus injection of furosemide in acute decompensated heart failure: systematic review and meta-analysis of randomised controlled trials. Anaesthesia. 2018;73(2):238–47.47. Albert Schweitzer Hospital, Lambarene, Gabon, and Institute of Tropical Medicine, University of Tübingen, Tübingen G. 需要引用的霍奇金第二肿瘤new England Journal. N Engl J Med. 2011;365:687–96.48. Frea S, Pidello S, Volpe A, Canavosio FG, Galluzzo A, Bovolo V, et al. Diuretic treatment in high-risk acute decompensation of advanced chronic heart failure—bolus intermittent vs. continuous infusion of furosemide: a randomized controlled trial. Clin Res Cardiol [Internet]. 2020;109(4):417–25. Available from: https://doi.org/10.1007/s00392-019-01521-y49. Herrero-Puente P, Jacob J, Martín-Sánchez FJ, Vázquez-Álvarez J, Martínez-Camblor P, Miró Ò, et al. Influence of Intravenous Nitrate Treatment on Early Mortality among Patients with Acute Heart Failure. NITRO-EAHFE Study. Rev Esp Cardiol. 2015;68(11):959–67.50. Llorens P, Miró Ò, Martín Sánchez FJ, Herrero Puente P, Jacob Rodríguez J, Gil V, et al. Manejo de la insuficiencia cardiaca aguda en los servicios de urgencias, emergencias y unidades adscritas. Documento de consenso del Grupo de Insuficiencia Cardiaca Aguda de la Sociedad Española de Medicina de Urgencias y Emergencias (ICA-SEMES). Emergencias. 2011;23(2):119–39.51. Holt DB, Pang PS. Vasodilator Therapies in the Treatment of Acute Heart Failure. Curr Heart Fail Rep. 2019;16(1):32–7.52. Kamran H, Tang WHW. Medical management of acute heart failure. Fac Rev. 2021 Dec 6;10:82. doi: 10.12703/r/10-82. PMID: 35028647; PMCID: PMC87256453. Mebazaa A, Tolppanen H, Mueller C, Lassus J, DiSomma S, Baksyte G, et al. Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance. Intensive Care Med. 2016;42(2):147–63.54. Butler J, Anstrom KJ, Felker GM, Givertz MM, Kalogeropoulos AP, Konstam MA, et al. Efficacy and safety of spironolactone in acute heart failure: The ATHENA-HF randomized clinical trial. JAMA Cardiol. 2017;2(9):950–8.55. Tomasoni D, Adamo M, Anker MS, von Haehling S, Coats AJS, Metra M. Heart failure in the last year: progress and perspective. ESC Hear Fail. 2020;7(6):3505–30.56. Mohyeldin M, Tavares LB, Boorenie M, Abureesh D, Ejaz S, Durrani L, et al. Efficacy of Sacubitril/Valsartan in the Setting of Acute Heart Failure: A Systematic Review. Cureus. 2021;13(10).57. Velazquez EJ, Morrow DA, DeVore AD, Duffy CI, Ambrosy AP, McCague K, et al. Angiotensin–Neprilysin Inhibition in Acute Decompensated Heart Failure. N Engl J Med. 2019;380(6):539–48.58. Wachter R, Senni M, Belohlavek J, Straburzynska-Migaj E, Witte KK, Kobalava Z, et al. Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge: primary results of the randomised TRANSITION study. Eur J Heart Fail. 2019;21(8):998–1007.59. Pablo A. Olavegogeascoechea. De la evidencia a la práctica en la insuficiencia cardíaca. Rev Argentina Med. 2017;5(2):132–3.60. Solomon SD, McMurray JJV, Anand IS, Ge J, Lam CSP, Maggioni AP, et al. Angiotensin–Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction. N Engl J Med. 2019;381(17):1609–20.61. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Vol. 145, Circulation. 2022. 895–1032 p.62. Damman K, Beusekamp JC, Boorsma EM, Swart HP, Smilde TDJ, Elvan A, et al. Randomized, double-blind, placebo-controlled, multicentre pilot study on the effects of empagliflozin on clinical outcomes in patients with acute decompensated heart failure (EMPA-RESPONSE-AHF). Eur J Heart Fail. 2020;22(4):713–22.63. Bhatt DL, Szarek M, Steg PG, Cannon CP, Leiter LA, McGuire DK, et al. Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure. N Engl J Med. 2021;384(2):117–28.64. Pandey A, Kitzman D, Whellan DJ, Duncan PW, Mentz RJ, Pastva AM, et al. Frailty Among Older Decompensated Heart Failure Patients: Prevalence, Association With Patient-Centered Outcomes, and Efficient Detection Methods. JACC Hear Fail. 2019;7(12):1079–88.65. Lemus Barrios GA, Morales Benavidez DC, López Salazar AM, Henao V, González-Robledo G. Assessment of frailty in cardiovascular disease: A necessary challenge. Rev Colomb Cardiol [Internet]. 2020;27(4):283–93. Available from: https://doi.org/10.1016/j.rccar.2019.12.01566. Moorhouse P, Rockwood K. Frailty and its quantitative clinical evaluation. J R Coll Physicians Edinb. 2013;42(4):333–40.67. Theou O, Campbell S, Malone ML, Rockwood K. Older Adults in the Emergency Department with Frailty. Clin Geriatr Med. 2018;34(3):369–86.68. Matsue Y, Kamiya K, Saito H, Saito K, Ogasahara Y, Maekawa E, et al. Prevalence and prognostic impact of the coexistence of multiple frailty domains in elderly patients with heart failure: the FRAGILE-HF cohort study. Eur J Heart Fail. 2020;22(11):2112–9.69. Díaz-Toro F, Nazzal Nazal C, Verdejo H, Rossel V, Castro P, Larrea R, et al. Factores asociados a fragilidad en pacientes hospitalizados con insuficiencia cardiaca descompensada. Rev Med Chil. 2017;145(2):164–71.70. Sloane PD, Cesari M. Research on Frailty: Continued Progress, Continued Challenges. J Am Med Dir Assoc [Internet]. 2018;19(4):279–81. Available from: https://doi.org/10.1016/j.jamda.2018.01.00371. Liang YD, Zhang YN, Li YM, Chen YH, Xu JY, Liu M, et al. Identification of frailty and its risk factors in elderly hospitalized patients from different wards: A cross-sectional study in China. Clin Interv Aging. 2019;14:2249–59.72. O’Caoimh R, Costello M, Small C, Spooner L, Flannery A, O’Reilly L, et al. Comparison of frailty screening instruments in the emergency department. Int J Environ Res Public Health. 2019;16(19):1–13.73. Wallis SJ, Wall J, Biram RWS, Romero-Ortuno R. Association of the clinical frailty scale with hospital outcomes. Qjm. 2015;108(12):943–9.74. Kanenawa K, Isotani A, Yamaji K, Nakamura M, Tanaka Y, Hirose-Inui K, et al. The impact of frailty according to Clinical Frailty Scale on clinical outcome in patients with heart failure. ESC Hear Fail. 2021;8(2):1552–61.75. Strandberg TE, Nieminen T. Future Perspectives on the Role of Frailty in Cardiovascular Diseases. Vol. 1216, Advances in Experimental Medicine and Biology. 2020. 149–152 p.76. Yaku H, Kato T, Morimoto T, Inuzuka Y, Tamaki Y, Ozasa N, et al. Risk factors and clinical outcomes of functional decline during hospitalisation in very old patients with acute decompensated heart failure: An observational study. BMJ Open. 2020;10(2).77. Szanton SL, Seplaki CL, Thorpe RJ, Allen JK, Fried LP. Socioeconomic status is associated with frailty: The Women’s Health and Aging Studies. J Epidemiol Community Health. 2010;64(1):63–7.78. Wang J, Hulme C. Frailty and socioeconomic status: A systematic review. J Public health Res. 2021;10(3):553–60.79. Aimo A, Barison A, Mammini C, Emdin M. The Barthel Index in elderly acute heart failure patients. Frailty matters. Int J Cardiol [Internet]. 2018;254:240–1. Available from: https://doi.org/10.1016/j.ijcard.2017.11.01080. Chivite D, Formiga F, Corbella X, Conde-Martel A, Aramburu Ó, Carrera M, et al. Basal functional status predicts one-year mortality after a heart failure hospitalization in elderly patients — The RICA prospective study. Int J Cardiol [Internet]. 2018;254:182–8. Available from: https://doi.org/10.1016/j.ijcard.2017.10.10481. Formiga F, Chivite D, Conde A, Ruiz-Laiglesia F, Franco ÁG, Bocanegra CP, et al. Basal functional status predicts three-month mortality after a heart failure hospitalization in elderly patients - The prospective RICA study. Int J Cardiol [Internet]. 2014;172(1):127–31.82. Claret PG, Stiell IG, Yan JW, Clement CM, Rowe BH, Calder LA, et al. Characteristics and outcomes for acute heart failure in elderly patients presenting to the ED. Am J Emerg Med [Internet]. 2016;34(11):2159–66.83. Wu Y, Zhu W, He X, Xue R, Liang W, Wei F, et al. Influence of polypharmacy on patients with heart failure with preserved ejection fraction: A retrospective analysis on adverse outcomes in the TOPCAT trial. Br J Gen Pract. 2021;71(702):E62–70.84. Beezer J, Al Hatrushi M, Husband A, Kurdi A, Forsyth P. Polypharmacy definition and prevalence in heart failure: a systematic review. Heart Fail Rev [Internet]. 2022;27(2):465–92.85. Unlu O, Levitan EB, Reshetnyak E, Kneifati-Hayek J, Diaz I, Archambault A, et al. Polypharmacy in Older Adults Hospitalized for Heart Failure. Circ Hear Fail. 2020;13(11):E006977.86. Mastromarino V, Casenghi M, Testa M, Gabriele E, Coluccia R, Rubattu S, et al. Polypharmacy in heart failure patients. Curr Heart Fail Rep. 2014;11(2):212–9.87. Reed BN, Rodgers JE, Sueta CA. Polypharmacy in Heart Failure. Drugs to Use and Avoid. Heart Fail Clin [Internet]. 2014;10(4):577–90.88. Pazan F, Wehling M. Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences. Eur Geriatr Med [Internet]. 2021;12(3):443–52.89. Rao VN, Fudim M, Savarese G, Butler J. Polypharmacy in Heart Failure with Reduced Ejection Fraction: Progress, Not Problem. Am J Med [Internet]. 2021;134(9):1068–70.90. Veenis JF, Brunner-La Rocca HP, Linssen GCM, Geerlings PR, Van Gent MWF, Aksoy I, et al. Age differences in contemporary treatment of patients with chronic heart failure and reduced ejection fraction. Eur J Prev Cardiol. 2019;26(13):1399–407.91. Milinković I, Polovina M, Coats AJ, Rosano GM, Seferović PM. Medical Treatment of Heart Failure with Reduced Ejection Fraction in the Elderly. Card Fail Rev. 2022;8.92. Younis A, Mulla W, Goldkorn R, Klempfner R, Peled Y, Arad M, et al. Differences in Mortality of New-Onset (De-Novo) Acute Heart Failure Versus Acute Decompensated Chronic Heart Failure. Am J Cardiol [Internet]. 2019;124(4):554–9.93. Formiga F, Moreno-Gonzalez R, Chivite D, Franco J, Montero A, Corbella X. High comorbidity, measured by the Charlson Comorbidity Index, associates with higher 1-year mortality risks in elderly patients experiencing a first acute heart failure hospitalization. Aging Clin Exp Res [Internet]. 2018;30(8):927–33.94. Franco Jonathan , Formiga Francesc , Chivite David,Corbella Javier, Robert Jordi, Vidaller Antonio, Charte Angel. Insuficiencia cardiaca aguda en el anciano:Características clínicas y mortalidad según la fracción de eyección ventricular izquierda.Rev Colomb Cardiol. 2017;24(3):250-25495. Kim V, Aaron SD. What is a COPD exacerbation? Current definitions, pitfalls, challenges and opportunities for improvement. Eur Respir J [Internet]. 2018;52(5). Available from: http://dx.doi.org/10.1183/13993003.01261-201896. Jacob J, Tost J, Miró Ò, Herrero P, Martín-Sánchez FJ, Llorens P. Impact of chronic obstructive pulmonary disease on clinical course after an episode of acute heart failure. EAHFE–COPD study. Int J Cardiol [Internet]. 2017;227:450–6.97. Van Den Berge JC, Van Vark LC, Postmus D, Utens EMWJ, Hillege HL, Boersma E, et al. Determinants of quality of life in acute heart failure patients with and without comorbidities: a prospective, observational study. Eur J Cardiovasc Nurs. 2022;21(3):205–12.98. Gulea C, Zakeri R, Kallis C, Quint JK. Impact of COPD and asthma on in- ­ hospital mortality and management of patients with heart failure in England and Wales : an observational analysis. 2022;1–10.99. Sung SH, Wang TJ, Cheng HM, Yu WC, Guo CY, Chiang CE, et al. Clinical Characteristics and Outcomes in the Very Elderly Patients Hospitalized for Acute Heart Failure: Importance of Pharmacologic Guideline Adherence. Sci Rep [Internet]. 2018;8(1):4–11.100. Arrigo M, Jessup M, Mullens W, Reza N, Shah AM, Sliwa K, et al. Acute heart failure. Nat Rev Dis Prim [Internet]. 2020;6(1). Available from: http://dx.doi.org/10.1038/s41572-020-0151-7101. Alvarado CS, Avila RY-, Marron-veria E, Málaga-zenteno J, Adamkiewicz T V, Hematología S De, et al. Avances en el diagnóstico y tratamiento de deficiencia de hierro y anemia ferropenica Advances in the diagnosis and treatment of iron deficiency and iron deficiency anemia. 2022;83(1):65–9.102. Chopra VK, Anker SD. Anaemia, iron deficiency and heart failure in 2020: facts and numbers. ESC Hear Fail. 2020;7(5):2007–11.103. Loncar G, Obradovic D, Thiele H, von Haehling S, Lainscak M. Iron deficiency in heart failure. ESC Hear Fail. 2021;8(4):2368–79.104. Rizzo C, Carbonara R, Ruggieri R, Passantino A, Scrutinio D. Iron Deficiency: A New Target for Patients With Heart Failure. Front Cardiovasc Med. 2021;8(August).105. Cunha GJL, Rocha BML, Menezes Falcão L. Iron deficiency in chronic and acute heart failure: A contemporary review on intertwined conditions. Eur J Intern Med. 2018;52(April):1–7.106. Tee SL, Sindone A, Roger S, Atherton J, Amerena J, D’Emden M, et al. Hyponatraemia in heart failure. Intern Med J. 2020;50(6):659–66.107. Matsue Y, Yoshioka K, Suzuki M, Torii S, Yamaguchi S, Fukamizu S, et al. Prognostic importance of sodium level trajectory in acute heart failure. Heart Vessels. 2017;32(12):1498–505.108. Liamis G, Filippatos TD, Elisaf MS. Thiazide-associated hyponatremia in the elderly: What the clinician needs to know. J Geriatr Cardiol. 2016;13(2):175–82.109. Carubelli V, Metra M, Lombardi C, Bettari L, Bugatti S, Lazzarini V, et al. Renal dysfunction in acute heart failure: Epidemiology, mechanisms and assessment. Heart Fail Rev. 2012;17(2):271–82.110. McCullough PA, Jefferies JL. Novel markers and therapies for patients with acute heart failure and renal dysfunction. Am J Med [Internet]. 2015;128(3):312.e1-312.e22. Available from: http://dx.doi.org/10.1016/j.amjmed.2014.10.035111. Matsue Y, Van Der Meer P, Damman K, Metra M, O’Connor CM, Ponikowski P, et al. Blood urea nitrogen-to-creatinine ratio in the general population and in patients with acute heart failure. Heart. 2017;103(6):407–13.112. Pourafkari L, Tajlil A, Nader ND. Biomarkers in diagnosing and treatment of acute heart failure. Biomark Med. 2019;13(14):1235–49.Fragilidad y características clínicas en pacientes muy ancianos con falla cardiaca agudaBibliotecariosEstudiantesInvestigadoresLICENSElicense.txtlicense.txttext/plain; charset=utf-85879https://repositorio.unal.edu.co/bitstream/unal/82595/1/license.txteb34b1cf90b7e1103fc9dfd26be24b4aMD51ORIGINAL1052385171.2022.pdf1052385171.2022.pdfTesis de Especialidad Médica en Geriatríaapplication/pdf1147028https://repositorio.unal.edu.co/bitstream/unal/82595/2/1052385171.2022.pdf9936e0a95551dbfcdf43ea4d0edafdadMD52unal/82595oai:repositorio.unal.edu.co:unal/825952023-01-11 14:30:05.42Repositorio Institucional Universidad Nacional de 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