Publications by authors named "Pablo Diez Villanueva"
Background: Chronic kidney disease (CKD) and frailty are often present in older patients with heart failure (HF). Our aim was to evaluate the association of CKD and frailty in one-year mortality in a cohort of older (≥75 years) outpatients with HF METHODS: Our data come from the FRAGIC study ("impacto de la FRAGilidad y otros síndromes Geriátricos en el manejo clínico y pronóstico del paciente anciano ambulatorio con Insuficiencia Cardíaca"), a multicenter prospective registry conducted in 16 cardiology services in Spain which included ≥75 years outpatients with HF. Renal function was assessed according to CKD-EPI formula.
View Article and Find Full Text PDFObjective: To assess the prognostic impact of a routine invasive strategy according to the frailty burden in patients with non-ST-segment elevation myocardial infarction (NSTEMI) from the MOSCA-FRAIL clinical trial.
Methods: The MOSCA-FRAIL trial randomized 167 frail patients, defined by a Clinical Frailty Scale (CFS) ≥ 4, with NSTEMI to an invasive or conservative strategy. The primary endpoint was the number of days alive and out of hospital (DAOH) one year after discharge.
Article Synopsis
- Differentiating tachycardia-induced cardiomyopathy (TIC) from dilated cardiomyopathy (DCM) is difficult for patients with heart failure (HF) and left ventricular dysfunction caused by supraventricular tachyarrhythmia (SVT).
- A study analyzed 43 patients admitted for HF due to SVT; those whose left ventricular ejection fraction (LVEF) improved were classified as TIC, while those with persistent low LVEF were classified as DCM.
- Key findings showed that diabetes, late gadolinium enhancement (LGE), low left ventricular peak systolic velocity, and specific right ventricular displacement measurements could help predict LVEF recovery and distinguish between TIC
Article Synopsis
- Self-care and empowerment in heart failure (HF) patients are crucial for better health outcomes, but there is limited information on their understanding of the condition and satisfaction with care.
- A study involving 281 patients from 14 heart failure units revealed that patients had a good grasp of their condition, with an average knowledge score of 80.7%, although some gaps remain.
- Despite these knowledge gaps, the majority of participants expressed high satisfaction with their care, with 98.2% likely to recommend the heart failure units to others.
Article Synopsis
- The MOSCA-FRAIL trial examined the effects of invasive versus conservative treatment strategies in frail patients aged 70 and older with non-ST-segment elevation myocardial infarction (NSTEMI).
- The study included 167 participants and focused on various geriatric conditions, finding that invasive management had a notable survival benefit primarily for those with lower frailty levels (CFS=4).
- Results suggested that frailty, as indicated by the Clinical Frailty Scale (CFS), is an important factor in determining the risks and benefits of treatment, with a CFS score greater than 4 potentially signaling a need for more cautious decision-making.
Article Synopsis
- * Effective management of NSTE-ACS requires personalized treatment plans, including specific diagnosis, antithrombotic therapies, and timely invasive interventions, particularly for vulnerable groups like the elderly and those with chronic kidney disease.
- * Emphasizing a multidisciplinary approach, the review underscores the importance of cardiac rehabilitation and managing cardiovascular risk factors as key components for improving outcomes and preventing future issues in NSTE-ACS patients.
Non-ST segment elevation myocardial infarction (NSTEMI) is the most frequent type of acute coronary syndrome in the elderly. Antithrombotic therapy is the cornerstone of pharmacological therapy in the setting of an acute ischemic event, a clinical scenario in which thrombotic and bleeding risks ought to be considered, particularly in older patients. In this article, specific aspects of antithrombotic therapy in elderly patients with NSTEMI are reviewed, including pharmacokinetic and pharmacodynamic characteristics and different clinical situations.
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- A study was conducted to evaluate the effectiveness of combining hypertonic saline solution (HSS) with furosemide in treating patients with worsening heart failure, focusing on potential improvements in diuretic response in an outpatient setting.
- The results showed no significant difference in short-term diuresis or natriuresis between the two treatment groups; however, the Furosemide-HSS group had slightly decreased weight after 7 days.
- Overall, the combination therapy did not lead to better outcomes in terms of congestion or kidney function compared to furosemide alone, suggesting it may not be beneficial in this context.
Article Synopsis
- - Cardiovascular disease is the leading cause of illness and death in older adults, with conditions like coronary artery disease and heart failure being particularly prevalent.
- - Cardiac rehabilitation (CR) is critical for secondary prevention, improving heart health, quality of life, and management of cardiovascular risk factors in elderly patients.
- - Despite its benefits, elderly patients are less frequently referred to CR following cardiovascular events, highlighting the need for personalized care strategies tailored to this unique population.
Article Synopsis
- Ventricular-arterial coupling is crucial for understanding heart and artery interaction and its role in cardiovascular issues.
- Traditionally measured with invasive techniques using pressure-volume loops, new methods like echocardiography and artificial intelligence have emerged for easier assessments.
- Improved assessments of this coupling can help identify at-risk patients and customize their treatment plans effectively.
The growing geriatric population presenting with coronary artery disease poses a primary challenge for healthcare services. This is a highly heterogeneous population, often underrepresented in studies and clinical trials, with distinctive characteristics that render them particularly vulnerable to standard management/approaches. In this review, we aim to summarize the available evidence on the treatment of acute coronary syndrome in the elderly.
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- The study examined how clinical management of nonST-segment elevation myocardial infarction (NSTEMI) differs between men and women, focusing on in-hospital events based on biological sex.
- A total of 1,020 patients were enrolled, with women being older and frailer on average; they were less likely to undergo timely coronary angiography compared to men.
- Despite differences in prescribed antithrombotic therapies, there were no significant disparities in the rates of coronary revascularization or in-hospital cardiovascular events between the sexes.
Introduction And Objectives: The optimal timing of coronary angiography in patients admitted with non-ST-segment elevation acute coronary syndrome (NSTEACS) as well as the need for pretreatment are controversial. The main objective of the IMPACT-TIMING-GO registry was to assess the proportion of patients undergoing an early invasive strategy (0-24hours) without dual antiplatelet therapy (no pretreatment strategy) in Spain.
Methods: This observational, prospective, and multicenter study included consecutive patients with NSTEACS who underwent coronary angiography that identified a culprit lesion.
Article Synopsis
- The MOSCA-FRAIL trial investigated treatment approaches for frail patients (aged ≥70) with non-ST-segment elevation myocardial infarction (NSTEMI) and found no significant difference in health outcomes after one year between invasive and conservative strategies.
- Following extended follow-up until January 2023, the analysis of 167 patients indicated similar survival times and readmission rates, revealing that neither treatment significantly outperformed the other.
- Overall, while initial outcomes suggested that invasive treatment might lead to shorter survival in the first year, the long-term results demonstrated inconclusive differences, highlighting the need for personalized treatment decisions in frail older adults.
Article Synopsis
- Heart failure (HF) is a common reason for elderly hospital admissions, particularly in women, who often experience higher rates of frailty; understanding the sex differences in frailty's impact on HF is crucial for tailored care.
- Research indicates that frailty is a key predictor of mortality and hospital readmissions in HF patients, but it affects men and women differently; frailty was found to be a predictor of poor outcomes mainly in men.
- Although women exhibit a higher prevalence of frailty, they tend to have lower mortality rates compared to men, suggesting that hormonal and psychosocial factors, along with the varying severity of HF, may play important roles in these differences.
Background: Spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS) constitute two common causes of nonatherosclerotic acute cardiac syndrome particularly frequent in women. Currently, there is no information comparing long-term clinical outcomes in unselected patients with these conditions.
Methods: We compared the baseline characteristics, in-hospital outcomes, and the 12-month and long-term clinical outcomes of two large prospective registries on SCAD and TTS.
Introduction: In addition to an increased risk of thromboembolic complications, patients with atrial fibrillation (AF) are at risk for vascular events. Consequently, complete vascular protection is warranted in these patients.
Areas Covered: A narrative search was conducted on PubMed (MEDLINE), using the MeSH terms [Rivaroxaban] + [Atrial fibrillation] + [Cardiovascular] + [Vascular] + [Treatment].
Article Synopsis
- * Patients with AF have a residual stroke risk of 1-2% annually even with anticoagulation therapy and may experience cognitive impairment through non-stroke-related pathways.
- * Both AF and atherosclerotic vascular disease are interconnected, indicating that patients with AF may also be at higher risk for kidney disease, requiring a holistic treatment strategy that encompasses vascular protection beyond medication.
Purpose Of Review: Heart failure (HF) entails poor prognosis, with high morbidity and mortality burden, particularly in elderly patients. Notably, important sex differences have been described between men and women with HF. In this regard, some biological and sociocultural aspects related to sex may play a key role in the different development and prognosis of HF in elderly men and women.
View Article and Find Full Text PDFBackground: Heart failure is associated with aging. It is one of the leading causes of morbidity and mortality in Western countries and constitutes the main cause of hospitalization among elderly patients. The pharmacological therapy of patients with heart failure with reduced ejection fraction (HFrEF) has greatly improved during the last years.
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- The study aimed to evaluate how well Spanish physicians, divided by sex, accept the European Clinical Practice Guidelines on heart failure, using a survey distributed to healthcare professionals in Madrid.
- A total of 387 physicians participated, with women being younger and having fewer years of clinical practice than their male counterparts, but both expressed a positive view on the guidelines and the feasibility of implementing quadruple therapy quickly.
- Women demonstrated a stronger adherence to the new treatment paradigm of "4 pillars at lowest doses," showed more willingness to establish quadruple therapy before cardiac device implantation, and were more proactive in starting SGLT2 inhibitors compared to men, indicating potential sex-related differences in guideline compliance that warrant further investigation.
Article Synopsis
- Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome, with patients presenting reduced left ventricular ejection fraction (LVEF) displaying different clinical features and outcomes compared to those with preserved LVEF.
- In a study of 389 patients, those with reduced LVEF (15% of participants) more often experienced severe presentations like ST-segment elevation myocardial infarction (STEMI) and had more extensive coronary artery involvement.
- Despite receiving specific medications, patients with reduced LVEF had significantly higher mortality rates (9% vs. 0.7%) and readmission for heart failure (4% vs. 0.3%) during a median follow-up of