Abstract
Objetivo
. Conocer las características de pacientes con insuficiencia cardíaca que requieren ingreso en el hospital de referencia del Área Sanitaria de A Coruña.
Diseño
. Estudio descriptivo, transversal y retrospectivo.
Emplazamiento
. Área sanitaria: 500.000 habitantes.
Pacientes u otros participantes
. Pacientes ingresados con diagnóstico de insuficiencia cardíaca (año 1995; n = 636). Se realizó muestreo aleatorio simple estratificado por sexo (n = 225; a = 0,05; precisión = 6%). El tamaño se incrementó un 25% por posibles pérdidas de información
Mediciones y resultados principales
. Las causas subyacentes más frecuentes fueron: cardiopatía isquémica: 36,4%; miocardiopatía dilatada, 23,6%, e hipertensión arterial, 16,5%. Los factores desencadenantes más frecuentes: infección, 32,6%, y taquicardia, 24,6%. Los síntomas más habituales: disnea, 90,6%, y ortopnea, 63,9%. Los crepitantes el signo más usual, 79,8%, seguido de edemas, 58,3%. Se realizó ecocardiograma al 42,6% y digoxinemia al 22,0%. La patología asociada más frecuente fue: hipertensión arterial, 33,5%, y EPOC, 25,0%. Tras el ingreso se incremento la utilización de diuréticos (30%), digoxina (9%) e inhibidores de la enzima de conversión de angiotensina (27%). Fallecieron un 7,7% de los pacientes. Las variables más frecuentemente asociadas al exitus han sido: infarto de miocardio (OR, 21,8), hiponatremia (OR, 12,2) e insuficiencia renal (OR, 7,04).
Conclusiones
. Teniendo en cuenta los resultados de este estudio en relación a las causas subyacentes y factores desencadenantes, consideramos que el médico de familia tiene un papel decisivo en la prevención y control de esta entidad.
Palabras clave: Insuficiencia cardíaca, Estudio descriptivo
Abstract
Objective
. To find the characteristics of patients with heart failure requiring admittance to the referral hospital for the A Coruña Health Area.
Design
. Descriptive, crossover and retrospective study.
Setting
. Health area of 500000 inhabitants.
Patients and other participants
. Patients admitted with diagnosis of heart failure (1995; n = 636). A simple randomised sampling was undertaken, stratified by sex (n = 225; α = 0.05; accuracy = 6%). Sample size was increased by 25% due to possible losses of information.
Measurements and main results
. The most common underlying causes were: ischaemic cardiopathy 36.4%, dilated myocardiopathy 23.6% and hypertension 16.5%. The most common catalysing factors were: infection 32.6% and tachycardia 24.6%. The commonest symptoms were dyspnoea 90.6% and orthopnoea 63.9%. The most frequent sign was crepitus 79.8%, followed by oedemas 58.3%. An echocardiogram was performed on 42.6% and 22% had digoxinaemia. Most common linked pathology was: hypertension 33.5% and COPD 25.0%. After admission the use of diuretics (30%), digoxin (9%) and ACE inhibitors (27%) was increased. 7.7% of patients died. Variables most commonly linked to death were myocardial infarction (OR = 21.8), hyponatraemia (OR = 12.2) and kidney failure (OR = 7.04).
Conclusions
. Given the underlying causes and catalysing factors seen in the results of this study, family doctors play a decisive role in prevention and control of heart failure.
Key words: Cardiac failure, Descriptive study
Bibliogrífia
- 1.McKee P.A., Castelli W.P., McNamara P.M., Kannel W.B. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971;285:1.441–1.446. doi: 10.1056/NEJM197112232852601. [DOI] [PubMed] [Google Scholar]
- 2.Sutton G.C. Epidemiologic aspects of heart failure. Am Heart J. 1990;120:1.538–1.540. doi: 10.1016/0002-8703(90)90055-3. [DOI] [PubMed] [Google Scholar]
- 3.Castro A., Crespo M.G., Muñiz J. Definición de la insuficiencia cardíaca. Epidemiología. In: Ferreira I., editor. Insuficiencia cardíaca. Visión Actual. Pharmazam; Madrid:: 1995. pp. 1–15. [Google Scholar]
- 4.Lobos Bejerano J.M., Díaz Sánchez S., Redondo Sánchez R. Evaluación de la insuficiencia cardíaca desde la consulta de Atención Primaria. FMC. 1997;4:10–23. [Google Scholar]
- 5.Ruiz M., Anguita M., De Zayas R., Berguillos F., Torres F., Giménez D. Características y evolución de los pacientes mayores de 65 años con insuficiencia cardiaca. Rev Esp Cardiol. 1996;49:253–258. [PubMed] [Google Scholar]
- 6.Clinical Quality Improvement Network Investigators Mortality risk and patterns of practice in 4606 acute care patients with congestive heart failure. Arch Intern Med. 1996;156:1.669–1.673. [PubMed] [Google Scholar]
- 7.The SOLVD Investigators Effect of enalapril on mortality and development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med. 1992;327:685–691. doi: 10.1056/NEJM199209033271003. [DOI] [PubMed] [Google Scholar]
- 8.Parameshwar J., Shackell M.M., Richardson A., Wilson P.A., Sutton G.C. Prevalence of heart failure in three general practices in north werst London. Br J Gen Pract. 1992:287–289. [PMC free article] [PubMed] [Google Scholar]
- 9.Mair F., Crowley T., Bundred P. Prevalence, aetiology and management of heart failure in general practice. Br J Gen Pract. 1996;46:77–79. [PMC free article] [PubMed] [Google Scholar]
- 10.López-Sendón J.L., Muñoz R., Palomo J., García J.A., Delcan J.L. Etiología de la insuficiencia cardíaca. Factores etiológicos y factores de riesgo. Factores agravantes y precipitantes. In: Ferreira I., editor. Insuficiencia cardíaca. Visión actual. Pharmazam; Madrid:: 1995. pp. 17–30. [Google Scholar]
- 11.Conthe P., Alonso M.A., Farfán A. Precipitating factors of admision by heart failure in a 2500 beds General Hospital. Jerusalem. 4th world Congress on Heart Failure. 1996 [Google Scholar]
- 12.Garg R., Yusuf S. Resultados globales de los ensayos clínicos aleatorizados acerca del efecto de los inhibidores de la enzima conversiva de la angiotensina de la mortalidad y morbilidad en pacientes con insuficiencia cardíaca. JAMA (ed. esp.) 1996;5:35–41. [Google Scholar]
- 13.The CONSENSUS Trial Study Group Effects of enalapril on mortality in severe congestive heart failure. N Engl J Med. 1987;316:1.429–1.434. doi: 10.1056/NEJM198706043162301. [DOI] [PubMed] [Google Scholar]
- 14.Vinson J.M., Rich M.W., Sperry J.C., Shash A.S., McNamara T. Early readmission of eldery patients with congestive heart failure. J Am Geriatr Soc. 1990;38:1.290–1.295. doi: 10.1111/j.1532-5415.1990.tb03450.x. [DOI] [PubMed] [Google Scholar]
- 15.Rich M.W., Freeland K.E. Effects of DRGS on three-month readmission rate of geriatric patients with congestive heart failure. Am J Public Health. 1988;78:680–682. doi: 10.2105/ajph.78.6.680. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.The AIRE study group Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet. 1993;342:821–828. [PubMed] [Google Scholar]
- 17.Pfeffer M., Braunwald E., MoyéM M., Basta L., Brown E., Cuddy T. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 1992;327:669–677. doi: 10.1056/NEJM199209033271001. [DOI] [PubMed] [Google Scholar]
- 18.Kober L., Torp-Pederson C., Carlsen J., Bagger H., Ellansen P., Lyngborg K. A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 1995;333:1.670–1.676. doi: 10.1056/NEJM199512213332503. [DOI] [PubMed] [Google Scholar]
- 19.Digitalis Investigation Group (DIG) Rationale design, implementation, and baseline characteristics of patients in the DIG trial: a large, simple, long-term trial to evaluate the effect of digistalis on mortality in heart failure. Control Clin Trials. 1996;17(1):77–97. doi: 10.1016/0197-2456(95)00065-8. [DOI] [PubMed] [Google Scholar]