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Vicente Valle

Publications and source records attributed to Vicente Valle.

At least 19 recordsLinked to original sources
PubMed2006

[Use of betablockers in elderly patients with congestive heart failure].

BACKGROUND AND OBJECTIVE: 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. PATIENTS AND METHOD: We evaluated clinical and functional characteristics of patients aged > or = 75 years with CHF treated with or without BB, with special interest being paid in the mortality. RESULTS: 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. CONCLUSIONS: 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.

Adrenergic beta-Antagonists↗
PubMed2006

Increased exercise capacity after surgically induced weight loss in morbid obesity.

OBJECTIVE: To investigate the effects of surgically induced weight loss on exercise capacity in patients with morbid obesity (MO). RESEARCH METHODS AND PROCEDURES: A prospective 1-year follow-up study was carried out, with patients being their own controls. A symptom-limited cardiopulmonary exercise stress test was performed in 31 MO patients (BMI > 40 kg/m2) before and 1 year after undergoing bariatric surgery. RESULTS: At 1 year after surgery, weight was reduced from 146 +/- 33 to 95 +/- 19 kg (p < 0.001), and BMI went from 51 +/- 4 to 33 +/- 6 kg/m2 (p < 0.001). After weight loss, obese patients performed each workload with lower oxygen consumption, heart rate, systolic arterial pressure, and ventilatory volume (p < 0.001). This reduced energy expenditure allowed them to increase the duration of their effort test from 13.8 +/- 3.8 to 21 +/- 4.2 minutes (p < 0.001). Upon finishing the exercise, MO patients before surgery were able to reach only 83% of their age-predicted maximal heart rate, and their respiratory exchange ratio was 0.87 +/- 0.06. After weight loss, those values were 90% and 1 +/- 0.08, respectively (p < 0.01). When we compared the peak O2 pulse corrected by fat free mass before and after surgery, no significant differences between the groups were found. DISCUSSION: After surgically induced weight loss, MO patients markedly improved their exercise capacity. This is due to the fact that they were able to perform the external work with lower energy expenditure and also to increase cardiovascular stress, optimizing the use of cardiac reserve. There were no differences in cardiac function before and after surgery.

Adult↗
PubMed2006

[Use of the European Heart Failure Self-care Behaviour Scale (EHFScBS) in a heart failure unit in Spain].

Self-care is important for patients with heart failure. Recently, the European Heart Failure Self-care Behaviour Scale was developed for its assessment. We evaluated 335 patients using the Spanish version of the scale and assessed whether self-care was influenced by sex, age, etiology, or follow-up duration at a heart failure unit. Possible scores on the scale range from 12 to 60, with a low score indicating good self-care. We observed a mean (SD) score of 24.2 (7.7). There was no significant correlation between the score attained and the value of any of the parameters analyzed, except for follow-up duration at the unit (r=-0.37; P<.001). The score was 28.1 (1.9) in patients evaluated at first visit, 23.1 (6.1) at three months, 24.1 (6.6) at six months, 23.3 (8.2) at nine months, 22.8 (7.3) at twelve months and finally 20.0 (5.5) in patients evaluated fifteen months after their first visit.

Adult↗
PubMed2006

[Clinical predictors of left main coronary artery disease in high-risk patients with a first episode of non-ST-segment elevation acute coronary syndrome].

INTRODUCTION AND OBJECTIVES: Risk stratification in non-ST-elevation acute coronary syndrome makes use of clinical variables that can identify patients at an increased risk of complications. Our objective was to identify clinical variables that predict significant stenosis (i.e., >50%) of the left main coronary artery in high-risk patients who have had a first episode of non-ST-elevation acute coronary syndrome but who do not have a history of coronary artery disease. METHODS: The study included 102 high-risk patients with no history of coronary artery disease who were admitted because of non-ST-elevation acute coronary syndrome. All underwent coronary angiography. Patients were divided into two groups: those with significant left main coronary artery stenosis (n=14) and those without (n=88). RESULTS: Univariate analysis showed that the variables significantly associated with left main coronary artery stenosis were age >65 years (57.1% vs 15.9%, P=.002), diabetes mellitus (71.4% vs 33.0%, P=.006), chronic renal failure (28.6% vs 5.7%, P=.019), left heart failure (71.4% vs 6.8%, P< .0001), cardiogenic shock (21.4% vs 1.1%, P=.008), and a low left ventricular ejection fraction at admission (49.9% [14.7%] vs 58.8% [9.9%], P=.044). In the multivariate analysis, the only significant independent predictor of left main coronary artery disease was left heart failure. CONCLUSIONS: The presence of left heart failure at initial assessment of high-risk patients with non-ST-elevation acute coronary syndrome but without a history of coronary artery disease could be a useful predictor of significant left main coronary artery disease.

Acute Disease↗
PubMed2005

[Prognostic significance of diabetes in a heart failure population: one year mortality and heart failure related hospital admission].

BACKGROUND AND OBJECTIVE: The relationship between diabetes mellitus and heart failure is not fully established. The aim of the study was to assess the prevalence of diabetes and its prognostic significance, considering mortality and the need of hospital admission due to heart failure during the first year of follow-up, in an outpatient population with heart failure attended in a specialized Unit. PATIENTS AND METHOD: We studied 362 patients -73% men; mean age (standard deviation) 65.3 (10.9) years-. Mean ejection fraction was 32.2% (12.7%). Patients were in New York Heart Association functional class I (5%), II (47%), III (43%) and IV (5%). RESULTS: One-hundred forty-three out of 362 patients were diabetic (39.5%). Thirty patients (8%) died and 70 (19%) needed to be hospitalized due to heart failure during the first year of follow-up. One year mortality was 5% in non-diabetic patients and 13.3% in diabetic patients (p = 0.005). 13.2% of non-diabetic patients suffered at least one episode of heart failure needing hospital admission, whereas 28.7% of diabetic patients needed to be hospitalized at least once (p < 0.001). In the multivariate regression analysis, diabetes remained statistically associated both with mortality and with the need of heart failure related hospital admission. CONCLUSIONS: Diabetes significantly correlated with a higher one year mortality as well as with a greater need of hospital admission due to heart failure. Prevalence of diabetes in a general population with heart failure was high.

Aged↗
PubMed2005

Patient's education by nurse: what we really do achieve?

AIM: To evaluate what is really achieved with nurse education in an outpatient heart failure population. METHOD: The answers obtained in a nurse questionnaire performed at the first visit to the Unit and at 1 year of follow-up were compared. The questionnaire was addressed to know how compliant patients were and how much they knew about their disease and their treatment. RESULTS: Two hundred and ninety eight patients (219 men and 79 women) were evaluated. Baseline mean age was 65 years (35-86). At first visit only 30% knew and understood the performance of the heart; 56% at 1 year (p<0.001). Only 28% initially understood the disease; 55% at follow-up (p<0.001). Awareness of more than 3 worsening signs increased from 66.5% to 86.5% (p<0.001). Knowledge of the names of all the pills they were receiving increased from 33% to 44% (p<0.001), of the action of these pills from 24% to 44% (p<0.001), and of how to use nitroglycerine among patients with ischemic heart disease from 87% to 96% (p<0.001). Initially 63% monitored their weight only at the medical visit and 21% monitored it at least once a week; at 1 year these percentages were 16% and 39% respectively (p<0.001). At baseline 45% checked blood pressure only at the medical visit and 28.5% checked it at least once a week; at 1 year these percentages were 12% and 43% (p<0.001). Whereas no significant differences were found in sodium restricted diet compliance, exercise performance increased slightly although statistically significantly (p=0.01). The great majority of patients never or only very rarely smoked or drunk alcoholic beverages, both at first visit and at 1 year, although both habits increased slightly during follow-up. No significant differences in treatment compliance (92% vs. 88% were taking all the medications prescribed) were found. CONCLUSION: Nurse-guided education has changed self-care behaviour of patients with heart failure in several important aspects, as weight and blood monitoring, and has increased their knowledge and understanding of the disease and treatment. However, these improvements have not been reflected in a better compliance of treatment and sodium restricted diet. Such aspects need more and more work to obtain better results.

Adult↗
PubMed2005

Sex and age differences in fragility in a heart failure population.

BACKGROUND: Heart failure (HF) patients have a high degree of fragility and dependence from physical, cognitive and psychological points of view, and are a mainly geriatric population. AIM: To detect the existence of fragility in all patients treated in a Heart Failure Unit and to evaluate age and sex differences. METHODS: All patients underwent a basic geriatric evaluation to detect possible loss of autonomy for doing basic and instrumental activities, cognitive deterioration, emotional disturbance or social risk. RESULTS: Three hundred sixty patients (mean age 65.2 years, 41.7% > or = 70 years, 27.5% women) were evaluated. Fragility was detected in 41.7% of patients, being more prevalent in patients > or = 70 years (p<0.001) and in women (p<0.001). A Barthel Index < 90 was found in 22.5% of patients and an anomalous OARS Scale was found in 18.3%. Pfeiffer test's score was abnormal in 7.8% of patients. A positive depression response in abbreviate GDS was observed in 29.7%. All items analysed were more prevalent in patients > or = 70 years and in women, with the unexpected exception of depression symptoms that were as prevalent in younger as in older patients. CONCLUSION: Fragility is common in patients with heart failure, even in younger patients, and can be detected easily using standardised geriatric scales. Prevalence of fragility was significantly higher in older patients and in women, although the presence of depression symptoms was as prevalent in younger as in older patients.

Adult↗
PubMed2005

[Prognostic significance of hemoglobin levels in patients with heart failure].

INTRODUCTION AND OBJECTIVES: To evaluate the prognostic significance of hemoglobin (Hb) levels in terms of 1-year mortality and hospital admissions due to heart failure (HF) during the first year of follow-up after the first visit to an outpatient HF unit. PATIENTS AND METHOD: Survival status and HF-related hospital admission rate at 1 year were analyzed for 337 patients admitted between August 2001 and March 2003. Plasma Hb level was measured at the first visit to the unit. RESULTS: 28 patients (8%) died and there were 158 HF-related hospital admissions in 66 patients. Plasma Hb level correlated strongly with survival at 1 year, and was 13.0 +/- 1.7 g/dL in patients who were alive after this time, versus 11.7 +/- 1.6 g/dL (P < .001) in patients who died. Plasma Hb level also correlated with HF-related need for hospital admission, and was 13.1 +/- 1.7 g/dL in patients who were not hospitalized, versus 12.2 +/- 1.7 g/dL (P < .001) in patients with at least one hospital admission. In the multivariate logistic regression analysis plasma Hb level remained statistically associated both with 1-year survival and with the need for HF-related hospital admission. On the basis of a cutoff value for anemia of Hb < 12 g/dL, 30% of the patients had anemia. One-year mortality was 17% in patients with anemia and 5% in patients without anemia (P < .001). Among patients without anemia, 31% had at least one HF-related hospital admission, whereas only a 15% of the patients without anemia needed to be hospitalized for HF (P = .001). CONCLUSIONS: Plasma Hb levels correlated inversely with mortality and with HF-related hospital admissions at 1 year. The prevalence of anemia (Hb < 12 g/dL) in the population with HF studied here was high and had independent prognostic value.

Aged↗
PubMed2005

[Reduction in heart failure hospitalization rate during the first year of follow-up at a multidisciplinary unit].

INTRODUCTION AND OBJECTIVES: Heart failure leads to frequent hospital readmissions. The aim of this study was to assess how receiving attention at our multidisciplinary unit influenced hospitalization for heart failure. We compared the number of admissions in the year preceding attendance with that in the first year of follow-up. PATIENTS AND METHOD: In total, 366 patients were admitted between August 2001 and June 2003. Of these, 332 were still alive and could be assessed clinically 1 year later. The most common etiologies were ischemic heart disease in 60%, and dilated cardiomyopathy in 10%. RESULTS: The number of admissions in the year preceding attendance was 246, while that during the first year of follow-up was 125, which corresponds to a statistically significant reduction of 49% (P<.001). The reduction was even greater (54%, P<.001), when only patients who were hospitalized more than once in the preceding year were analyzed. Moreover, in addition to the improvements noted during follow-up in patients' understanding of the disease and in several aspects of self-care, the increase in treatment use was also remarkable: beta-blocker use increased from 53% to 70%, spironolactone use from 20% to 30%, and statin use from 36% to 58%. CONCLUSIONS: The number of hospital admissions for heart failure among patients who received attention at our multidisciplinary unit was significantly less in the first year of follow-up than in the year preceding attendance. This reduction was probably due to educational and pharmacologic interventions and to closer follow-up.

Female↗
PubMed2004

Short-term (28 days) prognosis between genders according to the type of coronary event (Q-wave versus non-Q-wave acute myocardial infarction versus unstable angina pectoris).

The type of acute coronary syndrome may account for different prognoses between men and women after myocardial infarction. This study assessed gender differences in 28-day mortality rates for first or recurrent Q-wave and non-Q-wave myocardial infarctions and unstable angina by using data from 5 registries that included 20,836 patients (24.8% women). Mortality rates were higher in women with first Q-wave myocardial infarction but not in the other patients after adjusting for confounding variables.

Adult↗
PubMed2004

[Prevalence of anemia and its correlation with clinical parameters in patients from a multidisciplinary heart failure unit].

BACKGROUND AND OBJECTIVE: There is a high prevalence of anemia in patients with heart failure which is related to their outcome. The aim of the study was to evaluate the prevalence of anemia (haemoglobin < 12 g/dl) in patients attended in a Multidisciplinary Heart Failure Unit and to analyze the correlation of hemoglobin levels and the presence of anemia with demographic, clinic, biological and therapeutic parameters. PATIENTS AND METHOD: Between August 2001 and February 2003, 330 patients were attended (mean age [SD], 68.0 [9.3] years). Simple lineal regression, multiple lineal regression, *2 test, Student t test and Kruskal-Wallis test were used for statistical analysis. RESULTS: 30% patients had anemia. We found a significant correlation between plasmatic hemoglobin levels and age, gender, etiology of heart failure, coexistence of diabetes, absence of smoking habit, functional class, quality of life, plasmatic levels of urea, creatinine and cholesterol, treatment with diuretics and nitrates and the absence of treatment with betablockers. Surprisingly, there was no relationship between treatment with angiotensin-converting enzyme inhibitors, antiplatelet drugs or anticoagulants and the presence of low levels of hemoglobin. CONCLUSIONS: The prevalence of anemia in a general population with heart failure is high. Plasmatic hemoglobin levels were related to several parameters, mainly age, gender, functional class and plasmatic levels of urea and cholesterol.

Aged↗
PubMed2004

Giant thrombus trapped in foramen ovale with pulmonary embolus and stroke.

We describe the case of a young man who, while he was in coma because of a traffic accident, had first a pulmonary embolus and immediately afterwards had a systemic (cerebral) embolus. A transesophageal echocardiographic image revealed a giant thrombi trapped in foramen ovale protruding in right and left ventricles, diagnosing, thus, a paradoxical embolism. The relationship between patent foramen ovale and pulmonary embolism has been reported in some series. Elevated right-chamber pressure caused by pulmonary hypertension could favor the establishment of a right-to-left shunt, causing, in some cases, paradoxical embolisms. We review the clinical implications.

Accidents, Traffic↗
PubMed2004

Nurse evaluation of patients in a new multidisciplinary Heart Failure Unit in Spain.

AIM: To know how compliant patients are, how much they know about their disease and treatment, and how their level of self-care is. METHODS: We performed a short nurse questionnaire during the first visit to a new Heart Failure Unit. RESULTS: Three hundred and twenty-four patients have been evaluated, with a mean age of 65.4 years. Ninety-eight patients (30%) knew and understood the performance of the heart and 85 (29%) understood the disease. Two-hundred and nineteen (67%) knew more than three signs of worsening symptoms. One-hundred and five (32%) knew all the names of the medication they were taking and 74 (23%) knew the action of these medications. Two-hundred and ninety-four (91%) said they were taking all the medication prescribed and 229 (71%) carried on always their written prescription. Sixty-two percent of patients controlled weight only at the medical visit and only 14% controlled weight more than once a week. Fifty-nine (18%) controlled blood pressure more than once a week, while 45% controlled it only at the medical visit. Only 33% of patients were said always to follow sodium restricted diet. The great majority (93%) never smoked and only very rarely took alcohol (83%). While only 18 (6%) performed some kind of physical exercise, the majority (83%) did walking and daily living activities. The 85% of patients with ischemic heart disease knew how to use sublingual nitro-glycerine. When subgroups were analysed, we found significant differences by age, gender and previous specialist management. Younger patients, men and patients referred from the Cardiology outpatient clinic showed a higher level of knowledge and understanding of several aspects of disease and treatment, and performed more physical activities, compared to older patients, women and patients referred from other departments. On the contrary, older patients showed better adherence with sodium restriction, and, as women, better smoking and drinking habits. CONCLUSION: There is a lot of work to do in nurse-guided education of patients with heart failure, although treatment compliance, use of nitro-glycerine and abstinence of smoking and alcohol intake seem to be quite assumed by the majority of our patients. Significant differences in knowledge and behaviour were evident between younger and older patients, between men and women, and relating to previous specialist management. In spite of that, we found no differences in treatment compliance.

Adult↗
PubMed2004

[Use of the Minnesota Living With Heart Failure Quality of Life Questionnaire in Spain].

INTRODUCTION AND OBJECTIVES: Quality of life is an important end-point in heart failure studies, as well as mortality and hospitalization rates. The Minnesota Living With Heart Failure Questionnaire is the instrument used most widely to evaluate quality of life in research studies. We used this questionnaire to evaluate quality of life in a general population attended by a heart failure unit in Spain. PATIENTS AND METHOD: 326 patients seen for the first time at the unit were evaluated. We analyzed the relationship between the questionnaire score and different clinical and demographic factors. RESULTS: The median global score on the Minnesota Living With Heart Failure Questionnaire was relatively low (28). We found a strong correlation (P<.001) between the score and functional class, sex (women had higher scores), and diabetes. We also found a correlation between the score and number of hospital admissions in the previous year (P<.001), anemia (P<.001) and etiology (P=.01), and a weak trend toward higher scores with increasing age (P=.04). The highest scores were observed in patients with valve disease disorders (43), and the lowest were seen in patients with alcoholic cardiomyopathy (20) and ischemic heart disease (24). We found no correlation with time of evolution of heart failure or with left ventricular ejection fraction. CONCLUSIONS: The scores on the Minnesota Living With Heart Failure Questionnaire in a general population attended by a heart failure unit in Spain were relatively low. However, we found a strong correlation between this score and functional class, and also between this score and number of admissions in the previous year. These results suggest that the questionnaire adequately reflects the severity of the disease.

Adult↗
PubMed2004

[Temporary pacemakers: current use and complications].

INTRODUCTION AND OBJECTIVE: Temporary pacemakers (TP) are used in the emergency treatment of patients with severe bradyarrhythmia. They are often used in emergency situations and for older patients in poor general condition who are hemodynamically unstable and uncooperative. The aim of this study was to review and analyze the indications, incidence and type of complications associated with TP implanted in our center during a 6-year period. PATIENTS AND METHOD: We analyzed significant clinical variables, indication, route of insertion, follow-up, complications, and duration of temporary pacing. RESULTS: A total of 568 TP were implanted, and 530 cases were available for review (mean age 74.8 [11] years). The main indications were symptomatic complete AV block (51%), prophylaxis for replacement with a definitive pacemaker (14.7%), blockage in the acute phase of myocardial infarction (12.6%), bradyarrhythmia due to drug intoxication (12.2%), symptomatic sick sinus syndrome (7.5%) and long QT interval or ventricular tachycardia (2.5%). The route of insertion was via the femoral vein in 99% of the cases. The duration of TP use was 4.2 days (range 1 to 31 days). A total of 369 patients (69.6%) required a permanent pacemaker. COMPLICATIONS: 34 patients died (6.4%), but only 3 deaths were attributable to TP implantation. Other severe complications were seen in 98 patients (18.5%). Malfunction of the TP occurred in 48 patients (9%) because of electrode displacement. CONCLUSIONS: Temporary pacemakers are used in older patients with extreme bradyarrhythmia and occasionally with acute myocardial infarction. Serious complications are not uncommon (22% of all patients), and can range from femoral hematoma to cardiac tamponade and even death (6%). In 9% of the patients the electrode needed to be repositioned because of failure of sensing or loss of ventricular capture.

Adolescent↗