REC: CardioClinics最新文献

Conduction system pacing is a cardiac pacing modality that seeks to maintain ventricular electromechanical activation synchrony through direct stimulation of the specific conduction system, generally the bundle of His or the left bundle branch. Although technically more complex than conventional right ventricular pacing, the advent of dedicated tools has favored its implementation in clinical practice as a more physiologic alternative to conventional right ventricular pacing and as a rescue strategy when conventional resynchronization therapy through biventricular pacing is not feasible. More recently, the growing scientific evidence that compares it to the latter would place it as a real alternative strategy in patients with heart failure and an indication for resynchronization. This text reviews the fundamentals of the main implant modalities and technique, the available scientific evidence, and future prospects.

The IV edition of the Congress of Young Cardiologists, CardioMIR, was held in the city of Madrid on September 22 and 23, 2023, bringing together around 550 young cardiologists to learn about the latest developments in the diagnostic approach and therapeutics of cardiovascular disease. The congress also aims to be a meeting point for young cardiologists from the Spanish Society of Cardiology, especially residents, where they can share experiences and concerns. The aim of this article is to summarize of the main topics addressed in the IV edition of CardioMIR.

Health Economics is an unfriendly topic for most clinical cardiologists. However, if we want to bridge the gap between patients and healthcare management, it is essential that decisions regarding new drugs, procedures, and technologies involve clinical professionals. Our unique position allows us to provide valuable insights and expertise in our fields and bring added value for decision making in the health system as a whole. Equipping clinical cardiologists with basic knowledge and tools in Health Economics and Economic Evaluation (such as cost-effectiveness or cost-utility studies) is crucial to develop studies that accurately reflect the clinical impact of diseases, both for patients and the healthcare system. By getting involved, clinicians can play a vital role in shaping the future of healthcare systems and influencing the allocation of (usually scarce) resources to ensure optimal care for our patients.

Tricuspid regurgitation is the most prevalent valvular disease in the general population. However, it has traditionally been largely forgotten. This article reviews anatomy, etiology (with special attention to atriogenic tricuspid regurgitation), prognostic involvement, diagnostic methods, and therapeutic indication of this valve disease. In addition, the literature is reviewed regarding the selection of candidates, the importance of early management, surgery, and recent percutaneous treatment options, which are undoubtedly revolutionizing the management of this entity.

Introduction and objectives

To determine the current situation about the clinical management of heart failure (HF) in primary care (PC) and cardiology, in order to identify potential areas for improvement in the healthcare continuity.

Methods

The program was implemented through joint work sessions between PC and cardiology in our country, in which possible deficiencies, difficulties, and areas for improvement were identified in the integrative management of patients with HF.

Results

66 sessions were performed throughout Spain, with a total of 1187 attendees. 61.8% of the participants indicated that the healthcare centers did not have a HF cardiology referrer, in 64.7% the relationship between both healthcare levels was isolated and communication was carried out predominantly through telematic tools. 88.2% of PC physicians could request natriuretic peptides directly, but in 75.8% the echocardiogram had to be requested through cardiology. In 61.8% of the cases there was a therapeutic plan to optimize the treatment with quadruple therapy, although in 82.4% the full doses were not attained. In most centers (60.3%) there was no expert nurse in the management of HF.

Conclusions

In Spain there are significant deficiencies in the integrative management of patients with HF. A higher education of PC physicians and nurses, a better coordination between both healthcare levels, and the development of local protocols that facilitates treatment optimization, could be helpful to improve this situation.

Introduction and objectives

Evaluate patients referred for cardiac rehabilitation to determine the prevalence of cognitive impairment (CI) and compare readmission rates and mortality for those with and without CI.

Methods

Patients were retrospectively divided into cohort A (Mini-Cog completed) and cohort B (Mini-Cog not completed). Cohort A was then divided into A₁ (Mini-Cog positive for CI) and A₂ (Mini-Cog negative for CI).

Results

Of 1440 patients, 986 (68%) completed the Mini-Cog (cohort A) and 454 (32%) patients did not (cohort B). Within cohort A, 46 (4.7%) had a positive Mini-Cog (cohort A₁) and 940 (95.3%) had a negative Mini-Cog (cohort A₂). Cohort A₁ had significantly higher rates of all-cause readmission compared with cohorts A₂ and B (63% vs 44% and 47%; P = .02), and significantly higher mortality (28% vs 9% vs 15%; P < .001), but was also significantly older, with more co-morbidities. After accounting for demographic and co-morbidity differences between cohorts A₁ and A₂ using propensity score matching and Cox proportional hazards model, cohort A₁ had significantly increased rates of the composite outcome of readmission and/or death at 3-months (P = .002).

Conclusions

Poor performance on the Mini-Cog identified an older group of phase I cardiac rehabilitation patients that had significantly increased rates of the combined end-point of readmission plus death.

Introduction and objectives

Iron deficiency (ID) is common in heart failure (HF) patients and is linked to exercise impairment, worse quality of life, and HF hospitalisation. Clinical practice guidelines recommend checking and correcting ID with ferric carboxymaltose (FCM). However, there is a lack of evidence in patients with left ventricular ejection fraction (LVEF) >40%.

Methods

We included all HF outpatients treated with FCM after ID diagnosis (ferritin <100 ng/mL or ferritin 100–299 ng/mL and transferrin saturation <20%). We analysed clinical and analytical parameters before FCM administration and at 3 months according to LVEF: preserved (>50%), mildly reduced (41–49%), and reduced (<40%).

Results

We included 235 patients (51.5% female) aged 73.5 ± 10.7 years. Ninety-six patients have reduced LVEF (40.8%), 41 mildly reduced (17.4%), and 98 preserved (41.7%). Patients with preserved LVEF have more anaemia (42.6% vs 26.8% vs 52.6%; P = .02). Less than 50% of patients received the correct dose of FCM, especially patients with preserved LVEF (P = .004). One patient (0.4%) presented a local exanthema with no other adverse effects. At 3 months, all analytical parameters significantly improved, except haemoglobin (12.9 vs 13.0 mg/dL; P = .95) and natriuretic peptides (3261 vs 3471 pg/mL; P = .56) in mildly reduced LVEF patients. The functional class did not improve in preserved LVEF patients, but it did in the rest.

Conclusions

FCM is safe and effective in correcting ID in HF patients regardless of LVEF. Natriuretic peptides are reduced in all patients except those with mildly reduced LVEF. Functional class improvement is less likely in patients with preserved LVEF.