Search

Introduction. Heart failure and type 2 diabetes mellitus are critical public health issues. Objective. To characterize the risk factors for mortality in patients with heart failure and type 2 diabetes mellitus from a large registry in Colombia and to evaluate the potential effect modifications by type 2 diabetes mellitus over other risk factors. Materials and methods. Heart failure patients with and without type 2 diabetes mellitus enrolled in the Registro Colombiano de Falla Cardíaca (RECOLFACA) were included. RECOLFACA enrolled adult patients with heart failure diagnosis from 60 medical centers in Colombia during 2017-2019. The primary outcome was all-cause mortality. Survival analysis was performed using adjusted Cox proportional hazard models. Results. A total of 2514 patients were included, and the prevalence of type 2 diabetes mellitus was 24.7% (n = 620). We found seven independent predictors of short-term mortality for the general cohort, chronic obstructive pulmonary disease, sinus rhythm, triple therapy, nitrates use, statins use, anemia, and hyperkalemia. In the type 2 diabetes mellitus group, only the left ventricle diastolic diameter was an independent mortality predictor (HR = 0.96; 95% CI: 0.93-0.98). There was no evidence of effect modification by type 2 diabetes mellitus on the relationship between any independent predictors and all-cause mortality. However, a significant effect modification by type 2 diabetes mellitus between smoking and mortality was observed. Conclusions. Patients with type 2 diabetes mellitus had higher mortality risk. Our results also suggest that type 2 diabetes mellitus diagnosis does not modify the effect of the independent risk factors for mortality in heart failure evaluated. However, type 2 diabetes mellitus significantly modify the risk relation between mortality and smoking in patients with heart failure.

Introducción: La estratificación del riesgo de complicaciones mayores (incluyendo mortalidad) es, en la actualidad, la estrategia clínica fundamental para la toma de decisiones terapéuticas en pacientes con hipertensión arterial pulmonar. Sin embargo, es llamativo que la mayoría de pacientes se agrupan en la categoría intermedia, tanto en el momento del diagnóstico como en el seguimiento, con lo cual se hace relevante y necesario mejorar la discriminación y las opciones terapéuticas de los pacientes en riesgo intermedio. Objetivo: Definir una serie de recomendaciones sobre la propia subclasificación, el seguimiento y el tratamiento de pacientes adultos con hipertensión arterial pulmonar en riesgo intermedio adaptadas al contexto colombiano. Método: Se invitaron 15 expertos en hipertensión pulmonar quienes votaron de acuerdo con la metodología Delphi modificada en torno a catorce preguntas, sobre las cuales se realizó una revisión sistemática de la literatura en varias bases bibliográficas: BVS, Cochrane Library, PubMed, Medline y Web of Science. Se utilizaron los criterios MeSh y DeCs para cada pregunta, sin límite de idioma o tiempo. Resultados y discusión: El principal elemento de valor de la investigación está representado por dieciocho recomendaciones consensuadas sobre estratificación, tratamiento y otros apartados. Adicionalmente, la iniciativa permite identificar la escasez de estudios científicos que determinen el comportamiento de la enfermedad, las barreras de acceso y la disponibilidad de medicamentos en Colombia.

The impact of chronic obstructive pulmonary disease (COPD) on heart failure (HF) has yet to be well assessed in the Latin American population. This study aimed to analyze the impact of COPD on HF patients from the Colombian Heart Failure Registry (RECOLFACA). The primary outcome was all-cause mortality. A Cox proportional-hazards regression model was used to assess the impact of COPD on mortality. From the total of 2528 patients in the registry, 2514 patients had information regarding COPD diagnosis. COPD diagnosis was associated with a worse functional class and higher use of diuretics than non-COPD patients (p < 0.001). Patients with this comorbidity had a significantly better ejection fraction (median ejection fraction 35% vs. 32% in non-COPD patients; p = 0.004), with a higher occurrence of HF with preserved ejection fraction (HFpEF) in the COPD group (p = 0.000). Finally, patients with COPD had a significantly higher risk of mortality in the multivariate regression model (HR 1.47; 95% CI 1.02, 2.11). COPD is a prevalent comorbidity among patients with HF in Colombia, showing a different clinical profile and a worse functional class than patients without this condition. Patients with COPD and HFpEF have a high mortality risk according to our results.