Vargas SEA

Language: Spanish
References: 11
Page: 2-6
PDF size: 364.73 Kb.

ABSTRACT

Introduction: Heart failure is common final pathway of multiple cardiovascular conditions, with prevalence of 2.3% for Colombia, 4 to 6% meet criteria for advanced heart failure, with mortality of 75% per year from diagnosis. Chronic intermittent outpatient infusion of inotropics has shown an improvement in some severity parameters associated with this pathology.
Objective: evaluate the integral strategy of cardiology daycare management and its impact on requirement of hospitalizations and mortality in patients with advanced heart failure.
Method: Descriptive, observational cohort study, unicentric. 162 patients were admitted, after a comprehensive assessment at admission, presence of volume overload and decompensation determining factors, to receive Levosimendan at 0.2 mcg/kg/min for 8 hours, every 15 days, with follow-up to signs of decompensation.
Results: a one-year survival of 55.1% and 2-year survival of 42% was obtained. In year prior to admission, there were 402 hospitalization events, with an average duration of 8.85 days (SD: 5.29 interval: 0.1- 41.33), with respect to 264 hospitalization events in year after admission, with average hospitalization of 5.62 days (SD: 4.33 interval: 01.-35.67) representing a reduction in hospitalization events of 34.3% (t: 3.156, p: 0.002, CI: 0.195-0.838), and duration by 36.5% (t: 5.631 with p: 0.000).
Conclusions: Multidisciplinary and coordinated approach, around strategy of intermittent outpatient chronic infusion of inotropics, focused on the education of the patient and their caregivers, detecting and controlling decompensations early, can improve survival, rehospitalization rates in patients with advanced heart failure, compared with the isolated strategy of inotropic infusion.

REFERENCES

1. Crespo‐Leiro, M.G., Metra, M., Lund, L.H., Milicic, D., Costanzo, M.R., Filippatos, G., et al. (2018), Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail, 20: 1505-1535. doi:10.1002/ejhf.1236.

2. Metra, M., Dinatolo, E., & Dasseni, N. (2019). The New Heart Failure Association Definition of Advanced Heart Failure. Card Fail Rev. 5(1), 5–8. https://doi.org/10.15420/cfr.2018.43.1.

3. Truby L, Rogers J. (2020) Advanced Heart Failure: Epidemiology, Diagnosis, and Therapeutic Approaches. J Am Coll Cardiol Heart Fail. jun, 8 (7) 523–536.

4. Severino, P., Mather, P. J., Pucci, M., D'Amato, A., Mariani, M. V., Infusino, F., et al. (2019). Advanced Heart Failure and End-Stage Heart Failure: Does a Difference Exist. Diagnostics (Basel, Switzerland), 9(4), 170. https://doi.org/10.3390/diagnostics9040170.

5. Hashim, T.Sanam, K. Revilla-Martinez, M. Morgan, CJ.Tallaj, JA. Pamboukian, et al. (2015). Clinical characteristics and outcomes of intravenous inotropic therapy in advanced heart failure. Circ Heart Fail., 8, pp. 880-886. https://doi.org/10.1161/CIRCHEARTFAILURE. 114.001778.

6. Maciver, H. Ross. (2018) A palliative approach for heart failure end-of-life care. Curr Opin Cardiol., 33, pp. 202-207. doi: 10.1097/HCO.0000000000000484.

7. Comín-Colet J, Manito N, Segovia-Cubero J, Delgado J, García Pinilla JM, Almenar L, et al. LION-HEART Study Investigators. (2018) Efficacy and safety of intermittent intravenous outpatient administration of levosimendan in patients with advanced heart failure: the LION-HEART multicentre randomised trial. (2018). Eur J Heart Fail. jul;20(7):1128-1136. doi:10.1002/ejhf.1145

8. Ventura, Héctor O, & Salazar, Holger P. (2001). Infusión intermitente de inotrópicos en la insuficiencia cardíaca avanzada. Rev Costarric Cardiol, 3(2), 65-68. Retrieved March 12, 2021, from http://www.scielo.sa.cr/scielo.php?script=sci_arttext&pid=S1409-41422001000200010&lng=en&tlng=es

9. Gómez-Mesa, JE. Saldarriaga, C. Jurado, AM. Mariño, A. Rivera, A. Herrera, A. et al. (2019) Consenso colombiano de falla cardíaca avanzada: capítulo de Falla Cardíaca, Trasplante Cardíaco e Hipertensión Pulmonar de la Sociedad Colombiana de Cardiología y Cirugía Cardiovascular. Rev Col Cardiol. Volume 26, Supplement 2, 3-24, ISSN 0120-5633, https://doi.org/10.1016/j.rccar.2019.06.001

10. Manito, N. Rubio-Rodríguez, D. González, D. Díez-Lopez, C. Enjuanes, C. Segovia-Cubero, J. et al. En representación de los investigadores del estudio LION-HEART. (2020) Rev Esp Cardiol.73(5) :361–367. https://doi.org/10.1016/j.recesp.2019.06.019

11. Dobarro, D. Ribera-Solé, A. (2020) Infusiones ambulatorias de levosimendán: ¿eficaces y eficientes en la insuficiencia cardiaca avanzada? Rev Esp Cardiol. 73(5) :345–347. DOI: 10.1016/j.recesp.2019.11.020