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Vol. 70. Issue 7.
Pages 612 (July 2017)
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Vol. 70. Issue 7.
Pages 612 (July 2017)
Letter to the Editor
DOI: 10.1016/j.rec.2017.03.011
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About the Specialty Treating Patients With Heart Failure. Response
Sobre la especialidad que trata a los pacientes con insuficiencia cardiaca. Respuesta
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...
Jesús Álvarez-Garcíaa,
Corresponding author
jalvarezg@santpau.cat

Corresponding author:
, Prado Salamanca-Bautistab, Manuel Montero Pérez-Barqueroc, Juan Cincac
a Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
b Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
c Servicio de Medina Interna, Hospital Universitario Reina Sofía, Córdoba, Spain
Related content
Rev Esp Cardiol. 2017;70:61110.1016/j.rec.2017.02.033
Joan Carles Trullàs, Òscar Miró
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To the Editor,

We appreciate the interest shown by Dr Trullàs and Dr Miró in our study1 and would like to address the questions that they raise in their letter.

The differences in the variables analyzed between the RICA and REDINSCOR registries are a reflection of normal clinical practice, in which the 2 specialties (internal medicine and cardiology) manage the care of distinct patient types. However, the validity of the comparative analysis between the 2 specialties lies first in the statistical matching method (propensity score), which provided more than 500 pairs of patients matched for up to 18 prognostic predictors that are widely contrasted in the medical literature and second in the fact that both registries are national, multicenter registries and the quality of their data is guaranteed by their respective scientific societies. In our study, we acknowledge that the lack of information on frailty and dependence in REDINSCOR prevented us from assessing the potential effects of these factors on our results.

Regarding the criteria for the definition of “optimal medical treatment”, we would like to clarify that we refer to the simultaneous prescription of beta-blockers plus angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers plus aldosterone receptor antagonists only in patients with a left ventricular ejection fraction ≤ 35%. We agree that the percentages obtained were very low. This may be party explained by the lack of available data regarding reasons for not dispensing, as well as the fact that the inclusion periods for REDINSCOR and RICA began in 2007 and 2008, respectively, when the existing clinical practice guidelines2 limited the indication for triple therapy to patients in the advanced New York Heart Association functional class.

Last, the reasons for the lack of statistically significant differences in readmission rates were beyond the scope of our analysis and warrant a targeted study. However, we would like to reiterate that an independent data collection committee validated the events during follow-up.

References
[1]
J. Álvarez-García, P. Salamanca-Bautista, A. Ferrero-Gregori, et al.
Impacto pronóstico de la especialidad en el paciente ambulatorio con insuficiencia cardiaca: un análisis emparejado de los registros REDINSCOR y RICA.
Rev Esp Cardiol., 70 (2017), pp. 347-354
[2]
K. Dickstein, A. Cohen-Solal, G. Filippatos, et al.
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM).
Eur Heart J., 29 (2008), pp. 2388-2442
Copyright © 2017. Sociedad Española de Cardiología
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