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Introduccion. Los pacientes con insuficiencia cardiaca (IC) seguidos por los servicios de medicina interna son mas ancianos y presentan mas comorbilidades asociadas. Por ello presentan un riesgo elevado de ingreso hospitalario y de mortalidad. En este estudio se evaluaron los objetivos alcanzados en terminos de ingresos, visitas a urgencias y mortalidad, asi como la actividad realizada para conseguirlos, en una unidad dirigida a este perfil de pacientes y caracterizada por una atencion integral y continuada (programa UMIPIC). Metodos. Se analizaron retrospectivamente los datos de los 329 pacientes con IC atendidos en la unidad de IC, modelo UMIPIC, del servicio de Medicina Interna del Hospital de Lugo. Se recogieron desde enero del 2020, hasta diciembre 2020 los ingresos por IC y totales, las visitas a urgencias por IC y totales, la mortalidad, las consultas realizadas, y los rescates realizados en regimen de hospital de dia (HDD). Resultados. Se recogieron 108 ingresos, 40 por IC y 68 por otras causas, 99 visitas a urgencias, 25 por IC y 74 por otras causas. Se produjeron 57 fallecimientos, 37 fueron en el hospital (15 por IC, 12 por otras causas) y 20 fueron extra-hospitalarios. Se realizaron 1179 consultas medico-enfermeria, 1554 consultas de enfermeria exclusiva y se realizaron 406 tratamientos en HDD. Conclusiones. Los estandares de actividad y resultados conseguidos pueden ser orientativos de la actividad a desarrollar en una unidad de IC modelo UMIPIC.

In Spain, as in all other developed countries, heart failure is a colossal healthcare challenge. It is estimated that more than 1,300,000 people have heart failure in Spain. Each year, there are more than 100,000 hospital admissions for this process and the numbers are progressively increasing. Approximately 2% of emergency visits are related to this condition. Nearly 50% of inpatients are older than 75 years and have multiple comorbidities. Readmissions are common. Mortality at 1 year is around 16% after discharge but is close to 60% at 10 years. The associated annual overall costs are around 2,500 million euros. Every year more than 17,000 people die from heart failure, which is the fourth most frequent cause of death in Spain. Mortality rates have been reduced but, because of more advanced age at admission and the associated multiple comorbidities, in-hospital mortality has remained largely unchanged during the last 12 years and is nearly 10%. De novo heart failure causes greater morbidity and mortality and consequently there is a need for early identification and treatment. Strategies to coordinate healthcare levels and develop effective preventive programs are needed to tackle this formidable problem.

Resumen Fundamentos y objetivo La prescripcion de tratamiento con bloqueadores beta (BB) en pacientes ancianos con insuficiencia cardiaca (IC) es muy baja y esta condicionada en gran medida por el temor a sus efectos secundarios. El objetivo de nuestro estudio ha sido determinar la seguridad y la tolerancia de los BB en pacientes ancianos con IC tratados en servicios de medicina interna. Material y metodos Es un estudio observacional prospectivo, en condiciones de actuacion segun la practica clinica habitual, en el que se incluyo a 119 pacientes mayores de 70 anos con IC, atendidos en 10 servicios de medicina interna, que iniciaron tratamiento con un farmaco BB (carvedilol o bisoprolol) en el ultimo mes. A los 6 meses de seguimiento se analizo el porcentaje de pacientes que continuaban en tratamiento BB, la dosis alcanzada y las causas de retirada de la medicacion. Resultados Al final del estudio, 100 pacientes (84%) continuaban bajo tratamiento con BB y 10 pacientes lo habian suspendido (8,4%). Se produjeron 3 muertes (2,5%), ninguna atribuida al tratamiento BB, y 6 perdidas (5%). En total, el 38,7% de los pacientes alcanzo la dosis maxima. Los efectos adversos que motivaron la suspension del tratamiento fueron hipotension sintomatica (3 casos [2,5%]), hipotension asintomatica (un caso [0,8%]), IC (2 casos [1,7%]), bradicardia (2 casos [1,7%]), broncoespasmo (un caso [0,8%]) y causa desconocida (un caso [0,8%]). Conclusiones La seguridad y la tolerancia del uso de BB en los pacientes ancianos con IC tratados en la practica clinica del internista son excelentes.

In Spain, as in all other developed countries, heart failure is a colossal healthcare challenge. It is estimated that more than 1,300,000 people have heart failure in Spain. Each year, there are more than 100,000 hospital admissions for this process and the numbers are progressively increasing. Approximately 2% of emergency visits are related to this condition. Nearly 50% of inpatients are older than 75 years and have multiple comorbidities. Readmissions are common. Mortality at 1 year is around 16% after discharge but is close to 60% at 10 years. The associated annual overall costs are around 2,500 million euros. Every year more than 17,000 people die from heart failure, which is the fourth most frequent cause of death in Spain. Mortality rates have been reduced but, because of more advanced age at admission and the associated multiple comorbidities, in-hospital mortality has remained largely unchanged during the last 12 years and is nearly 10%. De novo heart failure causes greater morbidity and mortality and consequently there is a need for early identification and treatment. Strategies to coordinate healthcare levels and develop effective preventive programs are needed to tackle this formidable problem.

Prescription of beta-blockers (BB) in elderly patients with heart failure (HF) is very low, and it probably owes to an excessive concern about the risk of adverse reactions. The objective of our study was to determine the safety and tolerance of BB in elderly patients with HF in an Internal Medicine clinical practice.This observational prospective study of clinical practice included 119 patients older than 70 years with HF evaluated in 10 Internal Medicine services. Patients must have started treatment with BB (carvedilol or bisoprolol) within the last month. After 6 months of follow-up, the percentage of patients on BB, the dose achieved and the causes of withdrawal were analyzed.At the end of the study, 100 patients (84%) were on BB treatment. There were 3 deaths (2.5%), none related to BB use, and 6 losses to follow-up (5%). The treatment was stopped in 10 patients (8.4%). Maximum dose was achieved in 38.7% of the patients. Adverse reactions responsible for treatment withdrawal were: symptomatic hypotension (3 cases; 2.5%); asymptomatic hypotension (1 case; 0.8%); heart failure (2 cases; 1.7%); bradycardia (2 cases; 1.7%); bronchospasm (1 case; 0.8%); and unknown cause (1 case; 0.8%).BB are excellently tolerated in elderly patients with HF treated in an Internal Medicine setting.

espanolObjetivo: El objetivo de este estudio es determinar la repercusion de una consulta monografica para insuficiencia cardiaca cronica (ICC) y comorbilidad asociada,dirigida por internistas y enfermeria cualificada, sobre la hospitalizacion de estos pacientes. Material y Metodos: Estudio de cohortes prospectivo que incluye 456 pacientes ingresados en la unidad de Medicina Interna con ICC. Al alta los pacientes fueron distribuidos en dos grupos homogeneos, uno control que realizo seguimiento habitual, y otro de intervencion que fue seguido en consulta monografica de ICC. Se realizo un seguimiento desde en-06 hasta abril-09 y se compara en ambas cohortes el numero de visitas que realizan a urgencias, reingresos hospitalarios, promedio de reingresos y mortalidad en los ingresos. Resultados : Los pacientes del grupo intervenido frente a los del grupo control, acudieron a Urgencias significativamente menos (66% vs 155%) (p Conclusiones: El seguimiento por internistas y enfermeria de los pacientes con ICC y comorbilidad, basado en una atencion continuada e integral, en la informacion y en la disponibilidad; es un buen metodo para disminuir las visitas a urgencias y los reingresos, ademas de reducir la estancia y mortalidad hospitalaria. EnglishObjetive: The target of this study is to determine the impact of a monographic consultation for Chronic Heart Failure (CHF) which internists and specialized nursing have a main role, on the hospitalization of those patients. Material and Methods: Prospective cohort study included 456 patients admitted to the Internal Medicine Unit with CHF. Upon discharge patients were divided into two similar groups, one control group that went through routine monitoring, and one intervention group made of patients subject to monitoring through monographic consultation for CHF. The study was conducted from January 6th to April 9th. Both cohorts were compared in terms of the number of urgent service visits, hospital readmissions, readmission rates and mortality average at hospital admission. Results : The number of ER visits of patients subject to monitoring through monographic consultation as opposed to control group was considerably lower (66% vs 155%) (p Conclusion: In CHF and comorbility patients, following a health program in which internists and specialized nursing have a main role and which is based on a continuous and integral tracking, information / training and availability, is a good way to reducing urgents visits and readmissions, as well as reducing hospital stay and mortality.