Uso de bloqueadores beta en pacientes ancianos con insuficiencia cardíaca
Use of betablockers in elderly patients with congestive heart failure
Agustín Urrutiaa,
, Josep Lupóna, Salvador Altimira, Beatriz Gonzáleza, Joan Herrerosa, Crisanto Díeza, Ramón Colla, Vicente Vallea, Celestino Rey-Jolya
Autor para correspondencia
aurrutia@ns.hugtip.scs.es
Correspondencia: Dr. A. Urrutia. Servicio de Medicina Interna. Hospital Universitari Germans Trias i Pujol. Ctra. de Canyet, s/n. Badalona. Barcelona. España. aurrutia@ns.hugtip.scs.es
Correspondencia: Dr. A. Urrutia. Servicio de Medicina Interna. Hospital Universitari Germans Trias i Pujol. Ctra. de Canyet, s/n. Badalona. Barcelona. España. aurrutia@ns.hugtip.scs.es
a Unidad de Insuficiencia Cardíaca. Hospital Universitari Germans Trias i Pujol. Universitat Autònoma de Barcelona. Badalona. Barcelona. España
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Hospital Universitari Germans Trias i Pujol. Universitat Autònoma de Barcelona. Badalona. Barcelona. España" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "correspondencia" => "Correspondencia: Dr. A. Urrutia. Servicio de Medicina Interna. Hospital Universitari Germans Trias i Pujol. Ctra. de Canyet, s/n. Badalona. Barcelona. España. aurrutia@ns.hugtip.scs.es" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Use of betablockers in elderly patients with congestive heart failure" ] ] "pdfFichero" => "2v126n06a90151397pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec690901" "palabras" => array:3 [ 0 => "Bloqueadores beta" 1 => "Ancianos" 2 => "Insuficiencia cardíaca" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec690902" "palabras" => array:3 [ 0 => "Betablockers" 1 => "Elderly patients" 2 => "Congestive heart failure" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento y objetivo</span><br/><p class="elsevierStylePara">Diversos estudios han demostrado que los bloqueadores beta (BB) disminuyen la mortalidad en los pacientes afectados de insuficiencia cardíaca (IC), pero son pocos los estudios dirigidos específicamente a la población realmente anciana. Nuestro objetivo es analizar las características de los pacientes ancianos con IC tratados con BB y si este tratamiento se relaciona con una mejor evolución.</p><span class="elsevierStyleSectionTitle">Pacientes y método</span><br/><p class="elsevierStylePara">Hemos estudiado las características clínicas y funcionales de los pacientes de edad igual o superior a 75 años atendidos en la Unidad de Insuficiencia Cardíaca de nuestro hospital, hemos analizado las características diferenciales de los que tomaban BB frente a los que no los tomaban y evaluado la mortalidad de los 2 grupos de pacientes.</p><span class="elsevierStyleSectionTitle">Resultados</span><br/><p class="elsevierStylePara">Un total de 47 de 107 pacientes recibió tratamiento con BB. Sólo en 3 pacientes fue preciso retirar la medicación por intolerancia o efectos secundarios. El grupo que no recibió tratamiento era algo mayor, estaba en peor clase de la New York Heart Association (NYHA), tenía mayor prevalencia de enfermedad pulmonar obstructiva crónica (EPOC), aunque las diferencias no eran estadísticamente significativas, y mostraba peor situación funcional. Los que recibieron BB tenían mayor frecuencia de cardiopatía isquémica. Las razones por las que algunos pacientes no los recibieron fueron estenosis aórtica importante (n=2), insuficiencia mitral grave (n=9), asma-EPOC (n=28), vasculopatía periférica (n=16) y fragilidad (n=9). La cuarta parte de los pacientes tratados con BB alcanzó la dosis plena o el escalón de dosificación previo. La mortalidad tanto al año (un 5,7 frente al 27,6%) como a los 2 años (el 20,68 frente al 60%) fue significativamente inferior (p=0,01 y p=0,002, respectivamente) en los que pudieron recibir BB que en los no tratados.</p><span class="elsevierStyleSectionTitle">Conclusiones</span><br/><p class="elsevierStylePara">En nuestra experiencia, aproximadamente el 44% de los pacientes ancianos con IC de diversa etiología son tratados con BB, con buena tolerancia. Es más probable que estos fármacos se administren a los ancianos con cardiopatía isquémica, en mejor clase de la NYHA, con menor deterioro funcional y que no presenten EPOC grave. Los ancianos con IC que pueden recibir tratamiento con BB tienen menor mortalidad al año y a los 2 años.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Background and objective</span><br/><p class="elsevierStylePara">Few studies of betablockers (BB) have been performed specifically in older patients with congestive heart failure (CHF). We evaluated the characteristics of elderly patients with CHF treated with BB. Moreover, we assessed whether BB are associated with a better outcome in them.</p><span class="elsevierStyleSectionTitle">Patients and method</span><br/><p class="elsevierStylePara">We evaluated clinical and functional characteristics of patients aged ≥ 75 years with CHF treated with or without BB, with special interest being paid in the mortality.</p><span class="elsevierStyleSectionTitle">Results</span><br/><p class="elsevierStylePara">47 out of 107 patients were treated with BB. Only in 3 it was necessary to withdraw BB. Patients treated with no BB were older, with a higher New York Heart Association (NYHA) class, more prevalent chronic obstructive pulmonary disease (COPD) and in poorer functional situation. In patients treated with BB, ischemic heart disease was more prevalent. Reasons for «no treatment with BB» were severe aortic stenosis (n=2), severe mitral regurgitation (n=9), asthma-COPD (n=28), arterial disease (n=16) and fragility (n=9). 25% of the patients on BB reached the target dose. One-year mortality (5.7% vs 27.6%) and 2-year mortality (20.68% vs 60%) were both significantly lower (p=0.01 and p=0.002, respectively) in patients on BB.</p><span class="elsevierStyleSectionTitle">Conclusions</span><br/><p class="elsevierStylePara">44% of our elderly patients with CHF received BB with good tolerance. Patients treated with BB were younger, with more ischemic heart disease, better NYHA class, less functional deterioration and without COPD. One-year and two-year mortality in patients who can receive BB were lower.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliograf¿a" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med. 1996; 334:1349-55." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "The effect of carvedilol on morbidity and mortality in patients with chronic heart failure." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Packer M" 1 => "Bristow MR" 2 => "Cohn JN" 3 => "Colucci WS" 4 => "Fowler MB" 5 => "Gilbert EM" 6 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199605233342101" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med. 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" "fecha" => "2004" "volumen" => "164" "paginaInicial" => "1370" "paginaFinal" => "1371" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Características clínicas, tratamiento y morbimortalidad a corto plazo de pacientes con insuficiencia cardíaca controlados en consultas específicas de insuficiencia cardíaca. Resultados del registro BADAPIC. Rev Esp Cardiol. 2004; 57:1159-69." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Características clínicas, tratamiento y morbimortalidad a corto plazo de pacientes con insuficiencia cardíaca controlados en consultas específicas de insuficiencia cardíaca. Resultados del registro BADAPIC." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Anguita Sánchez M y los investigadores del registro BADAPIC." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol. 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Información del artículo
ISSN: 00257753Idioma original: Español
DOI:10.1157/13084869
Datos actualizados diariamente
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Octubre | 0 | 5 | 5 |
| 2024 Septiembre | 0 | 4 | 4 |
| 2024 Agosto | 0 | 2 | 2 |
| 2024 Julio | 0 | 3 | 3 |
| 2024 Junio | 0 | 2 | 2 |
| 2024 Mayo | 0 | 2 | 2 |
| 2024 Abril | 0 | 1 | 1 |
| 2024 Marzo | 0 | 12 | 12 |
| 2024 Febrero | 0 | 6 | 6 |
| 2024 Enero | 0 | 2 | 2 |
| 2023 Diciembre | 0 | 3 | 3 |
| 2023 Noviembre | 0 | 7 | 7 |
| 2023 Octubre | 0 | 8 | 8 |
| 2023 Septiembre | 0 | 3 | 3 |
| 2023 Julio | 0 | 7 | 7 |
| 2023 Junio | 0 | 1 | 1 |
| 2023 Mayo | 0 | 1 | 1 |
| 2023 Abril | 0 | 4 | 4 |
| 2023 Marzo | 0 | 8 | 8 |
| 2023 Febrero | 0 | 20 | 20 |
| 2023 Enero | 0 | 8 | 8 |
| 2022 Diciembre | 0 | 4 | 4 |
| 2022 Noviembre | 0 | 4 | 4 |
| 2022 Octubre | 0 | 5 | 5 |
| 2022 Septiembre | 0 | 21 | 21 |
| 2022 Agosto | 0 | 2 | 2 |
| 2022 Mayo | 0 | 2 | 2 |
| 2022 Abril | 0 | 3 | 3 |
| 2021 Noviembre | 0 | 2 | 2 |
| 2021 Agosto | 0 | 1 | 1 |
| 2021 Enero | 0 | 1 | 1 |
| 2020 Diciembre | 0 | 2 | 2 |
| 2020 Noviembre | 0 | 1 | 1 |
| 2020 Septiembre | 0 | 1 | 1 |
| 2020 Junio | 0 | 3 | 3 |
| 2020 Mayo | 0 | 2 | 2 |
| 2020 Abril | 0 | 1 | 1 |
| 2020 Marzo | 0 | 3 | 3 |
| 2020 Febrero | 0 | 2 | 2 |
| 2020 Enero | 0 | 4 | 4 |
| 2019 Diciembre | 0 | 7 | 7 |
| 2019 Noviembre | 0 | 1 | 1 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Agosto | 0 | 2 | 2 |
| 2019 Julio | 0 | 2 | 2 |
| 2019 Junio | 0 | 6 | 6 |
| 2019 Mayo | 0 | 24 | 24 |
| 2018 Septiembre | 0 | 1 | 1 |
| 2018 Agosto | 0 | 1 | 1 |
| 2017 Octubre | 1 | 0 | 1 |
| 2017 Septiembre | 9 | 3 | 12 |
| 2017 Agosto | 6 | 5 | 11 |
| 2017 Julio | 6 | 1 | 7 |
| 2017 Junio | 11 | 3 | 14 |
| 2017 Mayo | 12 | 2 | 14 |
| 2017 Abril | 13 | 3 | 16 |
| 2017 Marzo | 14 | 66 | 80 |
| 2017 Febrero | 22 | 0 | 22 |
| 2017 Enero | 12 | 0 | 12 |
| 2016 Diciembre | 21 | 4 | 25 |
| 2016 Noviembre | 31 | 4 | 35 |
| 2016 Octubre | 29 | 4 | 33 |
| 2016 Septiembre | 35 | 8 | 43 |
| 2016 Agosto | 36 | 3 | 39 |
| 2016 Julio | 31 | 9 | 40 |
| 2016 Junio | 58 | 10 | 68 |
| 2016 Mayo | 39 | 13 | 52 |
| 2016 Abril | 30 | 6 | 36 |
| 2016 Marzo | 41 | 5 | 46 |
| 2016 Febrero | 29 | 17 | 46 |
| 2016 Enero | 36 | 16 | 52 |
| 2015 Diciembre | 39 | 12 | 51 |
| 2015 Noviembre | 44 | 3 | 47 |
| 2015 Octubre | 58 | 11 | 69 |
| 2015 Septiembre | 44 | 8 | 52 |
| 2015 Agosto | 39 | 10 | 49 |
| 2015 Julio | 35 | 11 | 46 |
| 2015 Junio | 16 | 5 | 21 |
| 2015 Mayo | 23 | 8 | 31 |
| 2015 Abril | 40 | 13 | 53 |
| 2015 Marzo | 30 | 11 | 41 |
| 2015 Febrero | 23 | 11 | 34 |
| 2015 Enero | 48 | 1 | 49 |
| 2014 Diciembre | 42 | 5 | 47 |
| 2014 Noviembre | 28 | 3 | 31 |
| 2014 Octubre | 44 | 4 | 48 |
| 2014 Septiembre | 34 | 2 | 36 |
| 2014 Agosto | 30 | 1 | 31 |
| 2014 Julio | 36 | 10 | 46 |
| 2014 Junio | 43 | 3 | 46 |
| 2014 Mayo | 34 | 4 | 38 |
| 2014 Abril | 22 | 4 | 26 |
| 2014 Marzo | 26 | 9 | 35 |
| 2014 Febrero | 24 | 6 | 30 |
| 2014 Enero | 28 | 6 | 34 |
| 2013 Diciembre | 37 | 7 | 44 |
| 2013 Noviembre | 36 | 6 | 42 |
| 2013 Octubre | 40 | 7 | 47 |
| 2013 Septiembre | 21 | 5 | 26 |
| 2013 Agosto | 36 | 4 | 40 |
| 2013 Julio | 37 | 4 | 41 |
| 2006 Febrero | 897 | 0 | 897 |
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