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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
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28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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Does chronic kidney disease alter heart failure with reduced ejection fraction clinical course?
Session:
Posters 2 - Écran 7 - Insuficiência Cardíaca
Speaker:
Marta Sofia Ferreira Fonseca
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Marta Ferreira Fonseca; Tatiana Duarte; Sara Gonçalves; Rita Marinheiro; José Maria Farinha; Ana Fátima Esteves; Antonio Pinheiro Cumena Candjondjo; Rui Caria
Abstract
<p><strong>Introduction:</strong> Heart failure (HF) and chronic kidney disease (CKD) share several risk factors and often coexist with multiple interactions between both entities. Renal impairment may have an impact on the percentage of patients on maximal doses of disease-modifying therapies and consequently negatively affect HF hospitalizations and cardiovascular death. Although this seems reasonable, the majority of HF patients with severe renal impairment are excluded from studies, making management and prediction of outcomes difficult in this population.</p> <p><strong>Purpose:</strong> To determine the prevalence of renal dysfunction in a population with HF with reduced ejection fraction and to determine its impact on clinical outcomes.</p> <p><strong>Methods:</strong> We retrospectively evaluated consecutive patients from a HF outpatient’s clinic. Creatinine clearance was calculated according to the Cockcroft-Gault equation and patients were divided into 5 groups according to the degree of renal dysfunction: Group 1: GFR≥ 90; Group 2: <90 and ≥ 60; Group 3: <60 and ≥ 30; Group 4: <30 and ≥ 15; Group 5: <15 ml/min/1.73m2. The population was characterized according to clinical, laboratorial and echocardiographic characteristics. The adverse events considered were the occurrence of HF hospitalizations and cardiovascular death.</p> <p><strong>Results:</strong> We studied 178 patients (71% were male), with a mean age of 67 ± 11 years. Ninety-four patients (53%) had a GFR<60 ml/min/1.73m2. Patients with renal dysfunction were significantly older, but without predominance of gender or ischemic etiology (Table 1). The majority of patients with renal impairment were on ACE inhibitors therapy, but not on spironolactone. HF hospitalizations were significantly higher in patients with renal dysfunction (GFR <60 ml/min/1.73m2: 34% vs. 17%; p=0.019), however, the same was not found for cardiovascular death (10% vs 4%, p=0.146).</p> <p><strong>Conclusion:</strong> In this group of patients, renal impairment was frequent and was associated with HF hospitalizations, but not cardiovascular death. Its presence limited the use of some of the disease-modifying therapies, namely spironolactone, although it did not impact therapy with ACE inhibitors.</p>
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