Papers by Josep Comín-Colet
Revista espanola de cardiologia (English ed.), Jan 22, 2015
Although heart failure negatively affects the health-related quality of life of Spanish patients ... more Although heart failure negatively affects the health-related quality of life of Spanish patients there is little information on the clinical factors associated with this issue. Cross-sectional multicenter study of health-related quality of life. A specific questionnaire (Kansas City Cardiomyopathy Questionnaire) and a generic questionnaire (EuroQoL-5D) were administered to 1037 consecutive outpatients with systolic heart failure. Most patients with poor quality of life had a worse prognosis and increased severity of heart failure. Mobility was more limited and rates of pain/discomfort and anxiety/depression were higher in the study patients than in the general population and patients with other chronic conditions. The scores on both questionnaires were very highly correlated (Pearson r =0.815; P < .001). Multivariable linear regression showed that being older (standardized β=-0.2; P=.03), female (standardized β=-10.3; P < .001), having worse functional class (standardized β=-2...
Revista Española de Cardiología, 2015
Journal of telemedicine and telecare, Jan 7, 2015
The role of telemedicine in the management of patients with chronic heart failure (HF) has not be... more The role of telemedicine in the management of patients with chronic heart failure (HF) has not been fully elucidated. We hypothesized that multidisciplinary comprehensive HF care could achieve better results when it is delivered using telemedicine. In this study, 178 eligible patients with HF were randomized to either structured follow-up on the basis of face-to-face encounters (control group, 97 patients) or delivering health care using telemedicine (81 patients). Telemedicine included daily signs and symptoms based on telemonitoring and structured follow-up by means of video or audio-conference. The primary end-point was non-fatal HF events after six months of follow-up. The median age of the patients was 77 years, 41% were female, and 25% were frail patients. The hazard ratio for the primary end-point was 0.35 (95% confidence interval (CI), 0.20-0.59; p-value < 0.001) in favour of telemedicine. HF readmission (hazard ratio 0.39 (0.19-0.77); p-value=0.007) and cardiovascular re...
Heart failure reviews, Jan 4, 2015
Heart failure (HF) is commonly described according to the severity of symptoms, using the New Yor... more Heart failure (HF) is commonly described according to the severity of symptoms, using the New York Heart Association (NYHA) classification, and the assessment of ventricular function, by measuring the left ventricular ejection fraction (LVEF). It is important to acknowledge, however, that the severity of symptoms does not systematically correlate with the level of ventricular systolic dysfunction. Patients with no or only mild symptoms are still at high risk of HF-related morbidity and mortality. The objective of this review was to summarize the prevalence, characteristics, and treatment of patients with chronic HF and mild or no symptoms and to review epidemiological data from three recent registries conducted in Europe. From a clinical practice perspective, patients with a reduced ejection fraction who have only mild symptoms appear to represent a group of patients for whom the provision of adequate medical care is yet to be optimized. While prescription of angiotensin-converting ...
Quality in primary care, 2013
Multimorbidity and polypharmacy pose challenges to improving the quality of care. To determine th... more Multimorbidity and polypharmacy pose challenges to improving the quality of care. To determine the association between prescription of recommended treatment in ambulatory patients with chronic heart failure and multiple comorbidities and hospitalisation events. A population-based retrospective cohort study in Catalonia (north-east Spain). We included 7173 newly registered patients with chronic heart failure (59% women; mean [SD] age 76.3 [10.7] years). Patients were selected from the electronic patient records of primary care practices and followed for three years. Prescription of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs) and beta-blockers (BBs). Prescription of ACEI/ARBs in patients managed in primary care without a hospitalisation event during the follow-up rose from 50.8 to 83.5% for 0 and ≥4 comorbidities, respectively, and for ACEI/ARBs and BB from 13.1 to 30.6% for 0 and ≥4 comorbidities respectively. Patients with a hospitalisat...
Revista Española de Cardiología, 2013
ABSTRACT
Scarce research has been performed in ambulatory patients with chronic heart failure in the Medit... more Scarce research has been performed in ambulatory patients with chronic heart failure in the Mediterranean area. Our aim was to describe survival trends in our target population and the impact of prognostic factors. We carried out a population-based retrospective cohort study in Catalonia (north-east Spain) of 5659 ambulatory patients (60% women; mean age 77 [10] years) with incident chronic heart failure. Eligible patients were selected from the electronic patient records of primary care practices from 2005 and were followed-up until 2007. During the follow-up period deaths occurred in 950 patients (16.8%). Survival after the onset of chronic heart failure at 1, 2, and 3 years was 90%, 80%, 69%, respectively. No significant differences in survival were found between men and women (P=.13). Cox proportional hazard modelling confirmed an increased risk of death with older age (hazard ratio=1.06; 95% confidence interval, 1.06-1.07), diabetes mellitus (hazard ratio=1.53; 95% confidence interval, 1.33-1.76), chronic kidney disease (hazard ratio=1.73; 95% confidence interval, 1.45-2.05), and ischemic heart disease (hazard ratio=1.18; 95% confidence interval, 1.02-1.36). Hypertension (hazard ratio=0.73; 95% confidence interval, 0.64-0.84) had a protective effect. Service planning and prevention programs should take into consideration the relatively high survival rates found in our area and the effect of prognostic factors that can help to identify high risk patients.
Revista Española de Cardiología, 2014
Revista española de cardiología (English ed.), 2014
Revista española de cardiología (English ed.), 2012
Measurement of natriuretic peptides may be recommended prior to echocardiography in patients with... more Measurement of natriuretic peptides may be recommended prior to echocardiography in patients with suspected heart failure. Cut-off point for heart failure diagnosis in primary care is not well established. We aimed to assess the optimal diagnostic cut-off value of N-terminal pro-B-type natriuretic peptide on a community population attended in primary care. Prospective diagnostic accuracy study of a rapid point-of-care N-terminal pro-B-type natriuretic peptide test in a primary healthcare centre. Consecutive patients referred by their general practitioners to echocardiography due to suspected heart failure were included. Clinical history and physical examination based on Framingham criteria, electrocardiogram, chest X-ray, N-terminal pro-B-type natriuretic peptide measurement and echocardiogram were performed. Heart failure diagnosis was made by a cardiologist blinded to N-terminal pro-B-type natriuretic peptide value, using the European Society of Cardiology diagnosis criteria (clin...
International Journal of Cardiology, 2015
Obese patients with chronic Heart Failure (HF) have better outcome than their lean counterparts, ... more Obese patients with chronic Heart Failure (HF) have better outcome than their lean counterparts, although little is known about the pathophysiology of this obesity paradox. Our aim was to evaluate the hypothesis that patients with chronic HF and obesity (defined as body mass index (BMI)≥30kg/m(2)), may have an attenuated neurohormonal activation in comparison with non-obese patients. The present study is the post-hoc analysis of a cohort of 742 chronic HF patients from a single-center study evaluating sympathetic activation by measuring baseline levels of norepinephrine (NE). Obesity was present in 33% of patients. Higher BMI and obesity were significantly associated with lower NE levels in multivariable linear regression models adjusted for covariates (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Addition to NE in multivariate Cox proportional hazard models attenuated the prognostic impact of BMI in terms of outcomes. Finally, when we explored the prognosis impact of raised NE levels (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;70th percentile) carrying out a separate analysis in obese and non-obese patients we found that in both groups NE remained a significant independent predictor of poorer outcomes, despite the lower NE levels in patients with chronic HF and obesity: all-cause mortality hazard ratio=2.37 (95% confidence interval, 1.14-4.94) and hazard ratio=1.59 (95% confidence interval, 1.05-2.4) in obese and non-obese respectively; and cardiovascular mortality hazard ratio=3.08 (95% confidence interval, 1.05-9.01) in obese patients and hazard ratio=2.08 (95% confidence interval, 1.42-3.05) in non-obese patients. Patients with chronic HF and obesity have significantly lower sympathetic activation. This finding may partially explain the obesity paradox described in chronic HF patients.
PLoS ONE, 2014
Expression of emotional state is considered to be a core facet of an individual's emotional compe... more Expression of emotional state is considered to be a core facet of an individual's emotional competence. Emotional processing in BN has not been often studied and has not been considered from a broad perspective. This study aimed at examining the implicit and explicit emotional expression in BN patients, in the acute state and after recovery. Sixty-three female participants were included: 22 BN, 22 recovered BN (R-BN), and 19 healthy controls (HC). The clinical cases were drawn from consecutive admissions and diagnosed according to DSM-IV-TR diagnostic criteria. Self reported (explicit) emotional expression was measured with State-Trait Anger Expression Inventory-2, State-Trait Anxiety Inventory, and Symptom Check List-90 items-Revised. Emotional facial expression (implicit) was recorded by means of an integrated camera (by detecting Facial Feature Tracking), during a 20 minutes therapeutic video game. In the acute illness explicit emotional expression [anxiety (p,0.001) and anger (p,0.05)] was increased. In the recovered group this was decreased to an intermediate level between the acute illness and healthy controls [anxiety (p,0.001) and anger (p,0.05)]. In the implicit measurement of emotional expression patients with acute BN expressed more joy (p,0.001) and less anger (p,0.001) than both healthy controls and those in the recovered group. These findings suggest that there are differences in the implicit and explicit emotional processing in BN, which is significantly reduced after recovery, suggesting an improvement in emotional regulation.
Clin Chim Acta, 2010
La hiponatremia es un factor asociado a mal pronóstico bien conocido en pacientes que presentan i... more La hiponatremia es un factor asociado a mal pronóstico bien conocido en pacientes que presentan insuficiencia cardíaca (IC) crónica. Los mecanismos que conectan la hiponatremia con el mal pronóstico no están plenamente dilucidados, y posiblemente se hallen en relación a la presencia de un manejo inadecuado del agua libre y a la activación neurohormonal típica de los pacientes con IC crónica y que a su vez se asocian a peor evolución en ellos. Posiblemente, el grado de retención de agua libre sea superior a la proporción de retención de sodio en estos pacientes lo que, al menos parcialmente, explicaría la presencia de hiponatremia en la IC crónica. Hay diversas estrategias de tratamiento disponibles de la hiponatremia en la IC, aunque ninguna de ellas se ha mostrado demasiado eficaz, y que incluyen desde la restricción hídrica a la administración de tratamientos agresivos con diuréticos, pasando por la perfusión de suero salino hipertónico. Recientemente, el antagonismo de la vasopresina mediante los antagonistas de los receptores de la vasopresina ha conllevado una nueva vía de tratamiento de la hiponatremia en estos pacientes mediante la estimulación de la acuaresis. Hay diversos agentes disponibles, aunque aún no se ha establecido de forma plena el posible impacto de estos nuevos fármacos en la morbimortalidad de los pacientes que presentan hiponatremia en el contexto de la IC crónica.Hyponatremia is a well-known adverse prognostic factor in patients with chronic heart failure. The mechanisms linking hyponatremia with poor outcomes in these patients are not well understood and may be related to the presence of the abnormal management of water and neurohormonal activation seen in patients with chronic heart failure, which in turn are associated with a worse prognosis. Possibly, free-water retention exceeds the degree of sodium retention in chronic heart failure, which could partially explain the hyponatremia found in these patients. There are several therapeutic strategies for the management of hyponatremia in patients with chronic heart failure, including fluid restriction, high-dose diuretic administration and infusion of hypertonic saline, but none has been proven to be very effective. Recently, vasopressin antagonism through vasopressin receptor antagonists has opened up a new way of treating hyponatremia in these patients by enhancing aquaresis. Several agents are available but their possible impact on morbidity and mortality in patients with hyponatremia and chronic heart failure requires elucidation.
Revista espanola de cardiologia (English ed.), Jan 9, 2015
To evaluate the effect of iron deficiency and anemia on submaximal exercise capacity in patients ... more To evaluate the effect of iron deficiency and anemia on submaximal exercise capacity in patients with chronic heart failure. We undertook a single-center cross-sectional study in a group of stable patients with chronic heart failure. At recruitment, patients provided baseline information and completed a 6-minute walk test to evaluate submaximal exercise capacity and exercise-induced symptoms. At the same time, blood samples were taken for serological evaluation. Iron deficiency was defined as ferritin < 100 ng/mL or transferrin saturation < 20% when ferritin is < 800 ng/mL. Additional markers of iron status were also measured. A total of 538 heart failure patients were eligible for inclusion, with an average age of 71 years and 33% were in New York Heart Association class III/IV. The mean distance walked in the test was 285±101 meters among those with impaired iron status, vs 322±113 meters (P=.002). Symptoms during the test were more frequent in iron deficiency patients (3...
Revista española de cardiología, 2011
The mission of the Heart Failure and Transplantation Section of the Spanish Society of Cardiology... more The mission of the Heart Failure and Transplantation Section of the Spanish Society of Cardiology is to study, to promote interest in, and to disseminate information about all aspects of myocardial dysfunction and heart transplantation. Heart failure is a highly prevalent condition that consumes a substantial proportion of healthcare resources. Consequently, there is considerable interest in the disorder. Numerous lines of clinical and preclinical research are actively being pursued and new ways of increasing knowledge about the disease are constantly being explored. The aim of this article was to describe the most recent developments concerning heart failure and its treatment. Firstly, the latest publications on chronic heart failure are analyzed. Then, there is a review of the most recent studies on resynchronization therapy and of clinical trials on acute heart failure. Thirdly, new developments in right heart dysfunction and pulmonary hypertension, and the findings of the Spanis...
Revista española de cardiología, 2009
This article reports on the most significant developments in the field of heart failure in the pa... more This article reports on the most significant developments in the field of heart failure in the past year. Principal innovations in the management of chronic heart failure are explained, including the most important features of new management models for patients with chronic heart failure and the main advances in drug therapy and in the use of and indications for cardiac devices in these patients. In addition, recent progress in the treatment of advanced heart failure, with particular emphasis on acute heart failure, is reviewed. Novel approaches to the surgical management of patients with heart failure, including new contributions in the field of the circulatory support, are also highlighted in this update.
European Journal of Heart Failure, 2015
Transfusion Alternatives in Transfusion Medicine, 2012
ABSTRACT SUMMARY Anemia has been associated to poor outcomes in the whole spectrum of patients wi... more ABSTRACT SUMMARY Anemia has been associated to poor outcomes in the whole spectrum of patients with heart disease. The etiology of this comorbidity in cardiac patients is multifactorial but acute bleeding or chronic occult blood loss, iron deficiency and inflammation are common causes in these patients. Abnormal handling or availability of iron and inadequate response to endogenous erythropoietin have both raised the interest of researchers and clinicians to explore the therapeutic role of these agents either alone or in combination. In this review, we analyze the most recent research evaluating the role of iron alone or in combination with erythropoietin in the management of anemia of cardiac patients ranging from those patients that undergo cardiac surgery to those more advanced patients with chronic heart failure.
Endocrinología y Nutrición, 2010
Revista Española de Cardiología (English Edition), 2004
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Papers by Josep Comín-Colet