Abstract: Chronic obstructive pulmonary disease (COPD) is commonly associated with heart failure. Individuals with COPD have a 4.5-fold greater risk of developing heart failure than those without. The sensitivity and specificity of clinical judgment in the diagnosis of heart failure in patients with COPD can be enhanced by biological markers such as B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide. Correct interpretation of imaging results (mainly echocardiographic findings) and lung function tests can also help establish the co-occurrence of both conditions. There is little evidence on the management of patients with COPD and heart failure, although treatment of COPD undeniably affects the clinical course of patients with heart failure and viceversa.
Abstract: BACKGROUND AND OBJECTIVE: The aim of our study was to establish weather N-terminal fragment of brain-type natriuretic peptide (NT-proBNP) is useful in the differential diagnosis of dyspnea in elderly patients, and whether its determination has a prognostic value in heart failure (HF). PATIENTS AND METHOD: 79 patients admitted with acute dyspnea at the emergency department were included in our study. The mean age (standard deviation) was 77.56 (8.71) years. 67% had a diagnosis of HF based on clinical and echocardiagraphic criteria. A follow-up of 18 months was performed after discharge. RESULTS: Higher levels of NT-proBNP were found in patients with HF (6,833.54 pg/ml) than in patients with other causes of dyspnea (1,801.99 pg/ml) (p < 0.0001). A cut-off point of NT-proBNP > 730 pg/ml was related to higher rates of readmission due to HF over the next 18 months. CONCLUSIONS: NT-proBNP is a useful biomarker in the differential diagnosis of dyspnea in the elderly population. Its determination has a prognostic roll, stratifying the risk of readmission in HF patients.
Abstract: INTRODUCTION: To evaluate the utility of a day hospital managed by a multidisciplinary heart failure (HF) team composed of nurses, geriatricians and internal physicians in the reduction of hospital readmission of elderly patients with HF who are not selected by their left ventricular ejection fraction (LVEF). MATERIAL AND METHODS: 182 patients with mean age of 76 years and decompensated HP who required admission in internal medicine and geriatric wards were included. A total of 51 patients were followed up in a day hospital, where education, phone access, drug titration and use of parenteral diuretics were performed. Readmission due to HF at 3 months post-hospitalization was measured. A bivariate analysis was performed in both groups using parametrics test (p < 0.05) and a Kaplan Meier analysis using log rank. RESULTS: A total of 61% were women. Mean NYHA class was 2.75 +/- 0.44. LVEF < 45% was found in 40%. Prescription rate of beta blockers was significantly higher in the intervention group (93% vs 24%; p < 0.001) as well as ACE-inhibitors and ARB prescription rates (96% vs 72%, p = 0.002). Readmission rate due to HF in the first 90 days after discharge was lower in the intervention group (11% vs 28%; p = 0.020). HF admission free time was longer for these patient than those managed with conventional care (85.12 days versus 76; log rank; p = 0.026). DISCUSSION: Multidisciplinary intervention carried out by generalist physicians and HF nurses in a day hospital is useful to reduce HF admission in elderly patients not selected by their LVEF.
