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Introduction and Objectives: Hyperkalemia is a growing concern in the treatment of patients with heart failure and reduced ejection fraction because it limits the use of effective drugs. We report estimates of the magnitude of this problem in routine clinical practice in Spain, as well as changes in potassium levels during follow-up and associated factors., Methods: This study included patients with acute (n=881) or chronic (n=3587) heart failure recruited in 28 Spanish hospitals of the European heart failure registry of the European Society of Cardiology and followed up for 1 year. Various outcomes were analyzed, including changes in serum potassium levels and their impact on treatment., Results: Hyperkalemia (K + > 5.4 mEq/L) was identified in 4.3% (95%CI, 3.7%-5.0%) and 8.2% (6.5%-10.2%) of patients with chronic and acute heart failure, respectively, and was responsible for 28.9% of all cases of contraindication to mineralocorticoid receptor antagonist use and for 10.8% of all cases of failure to reach the target dose. Serum potassium levels were not recorded in 291 (10.8%) of the 2693 chronic heart failure patients with reduced ejection fraction. During follow-up, potassium levels increased in 179 of 1431 patients (12.5%, 95%CI, 10.8%-14.3%). This increase was directly related to age, diabetes, and history of stroke and was inversely related to history of hyperkalemia., Conclusions: This study highlights the magnitude of the problem of hyperkalemia in patients with heart failure in everyday clinical practice and the need to improve monitoring of this factor in these patients due to its interference with the possibility of receiving optimal treatment., (Copyright © 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The objective was to determine what percentage of patients admitted for heart failure met criteria for cardiac resynchronization therapy., Methods: The study involved registry data on heart failure admissions at 16 public hospitals in Andalusia, Spain between May and July 2004. Criteria for cardiac resynchronization therapy from American College of Cardiology and American Heart Association guidelines were applied: a left ventricular ejection fraction < or = 0.35, New York Heart Association functional class III or IV, and a QRS interval > 120 ms. Outcome was evaluated at 3 months. Multivariate (i.e., logistic regression) analysis was used to identify independent variables associated with meeting resynchronization therapy criteria., Results: The study included 674 patients (43.3% women, mean age 71[11] years). Of these, 5.6% met resynchronization therapy criteria at admission. There was no significant difference in the cardiovascular event rate at 3 months between patients who met resynchronization therapy criteria and those who did not (34.2% vs 23.4%, respectively). Admitting hospital (odds ratio [OR]=0.30, 95% confidence interval [CI], 0.11-0.79), ischemic etiology (OR=2.71, 95% CI, 1.26-5.81), the presence of left bundle branch block (OR=14.97, 95% CI, 5.95-37.64), and mitral regurgitation (OR=4.18, 95% CI, 1.93-9.04) were all independently associated with meeting resynchronization therapy criteria at both admission and short-term follow-up., Conclusions: The percentage of patients who met cardiac resynchronization therapy criteria was small, but their short-term prognosis was poor. A number of clinical variables associated with meeting resynchronization therapy criteria were identified.

Introduction and Objectives: The treatment of infective endocarditis has undergone significant change within the last few years. The aim of this study was to evaluate the clinical features and prognosis of infective endocarditis over both the short and long term in patients who are not intravenous drug users., Patients and Method: We carried out a prospective study of 222 consecutive patients who were diagnosed with infective endocarditis between 1987 and June 2001 at two centers., Results: Their mean age was 48 (19) years, with 145 (65%) being male. Overall, 154 (69%) had native valve endocarditis and 68 (31%) had prosthetic valve endocarditis. In 61 patients (27%), no predisposing heart disease was found. Staphylococci were the causal microorganisms in 37% of cases (81 patients), and streptococci, in 35% (78 patients). Some 48% of patients underwent surgery during the active disease phase. Overall, inpatient mortality was 17% (39 cases); a significant decrease had occurred in recent years, from 25% in 1989-1995 to 12% in 1996-2001 (P<.01). In addition, the percentage undergoing early elective surgery had increased between the two periods, from 22% to 32% (P<.05). During a follow-up of 60 (48) months, 15 patients (8%) needed late cardiac surgery and 18 (10% of the whole series) died. The 6-year survival rate was 72% overall, and 80% in those who survived the active disease phase., Conclusions: Short- and long-term prognoses for patients with infective endocarditis appear to have improved over recent years at our hospitals.