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Vol. 69. Issue 2.
Pages 233-234 (February 2016)
Vol. 69. Issue 2.
Pages 233-234 (February 2016)
Letter to the Editor
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Heart Failure and Age
Insuficiencia cardiaca y edad
José Manuel Ribera Casadoa, Francisco Javier Martín Sánchezb,c,
Corresponding author

Corresponding author:
a Profesor Emérito, Universidad Complutense de Madrid, Madrid, Spain
b Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Spain
c Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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María G. Crespo-Leiro, Javier Segovia-Cubero, José González-Costello, Antoni Bayes-Genis, Silvia López-Fernández, Eulàlia Roig, Marisa Sanz-Julve, Carla Fernández-Vivancos, Manuel de Mora-Martín, José Manuel García-Pinilla, Alfonso Varela-Román, Luis Almenar-Bonet, Antonio Lara-Padrón, Luis de la Fuente-Galán, Juan Delgado-Jiménez
Rev Esp Cardiol. 2016;69:23410.1016/j.rec.2015.11.010
María G. Crespo Leiro, Juan F. Delgado Jiménez
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To the Editor,

We read with interest the article by Crespo-Leiro et al. on treatment adherence in outpatients with heart failure (HF). The article highlighted at least 2 important points: the high standard of prescribing in this area by cardiologists and, most notably, the good treatment adherence in the patients studied,1 with figures much better than those reported in previous publications.2

Our comments and objections relate to the patients’ age, a detail that was not mentioned in the discussion, even in the section on limitations. The mean age of the patients was 65 years, and no patients were older than 73 years. This was surprising and seriously calls into question the representativeness of the whole study.

The age at which HF presents is increasingly older. The incidence and prevalence of the syndrome double every decade from the age of 45 years.3 Over the last 40 years, the age at first episode has increased by some 15 years, and 70% of patients admitted for heart failure are older than 70 years.4,5

Epidemiological data are in line with the literature on the subject, such as the successive NHANES reports and the PRICE study in Spain.4 In a study of close to 6000 patients carried out in Spanish emergency departments, the mean patient age was 79.4 years, and only 8.5% were younger than 65 years.5 The Rotterdam study reported a HF prevalence of 0.9% in 55 to 64-year-olds, and 17.4% in those older than 85 years; the incidence was 1.4/1000 in 55 to 59-year-olds and 47.4/1000 in those older than 90 years.6 The Swedish HF hospital registry is very significant, due to the number of patients included: it spanned 12 years and included 156 919 patients with a primary discharge diagnosis of HF (295 425 if secondary diagnoses are included); only 8% of the men and 5% of the women were younger than 65 years.7

An explanation is required. One, very weak, explanation is that the authors concentrated on outpatients; a more convincing explanation is that the study was carried out only by cardiologists in cardiology clinics, when in reality HF is managed by many other specialties (such as general practice, health care for the elderly, and general medicine). One registry, spanning an entire year of data from Hospital Clínico San Carlos, Madrid, showed that, of almost 1000 diagnoses of HF appearing in discharge reports that year, fewer than 200 were from the cardiology department. The mean age of those cardiology patients was 70.9 years, while patients from general medicine had a mean age of 80 years, and those from health care for the elderly, 88 years.8

Although some progress has been made, there is more ground to be covered by the official scientific societies that represent cardiology in Europe and in Spain. Complex and highly prevalent syndromes such as HF must be studied from a broader perspective and should not be limited to cardiologists in order to eliminate significant biases such as that found in the study prompting these comments.

M.G. Crespo-Leiro, J. Segovia-Cubero, J. González-Costello, A. Bayes-Genis, S. López-Fernández, E. Roig, et al.
Adecuación en España a las recomendaciones terapéuticas de la guía de la ESC sobre insuficiencia cardiaca: ESC Heart Failure Long-Term Registry.
Rev Esp Cardiol., 68 (2015), pp. 785-793
P. Llorens, N. Manito Lorite, L. Manzano Espinosa, F.J. Martín-Sánchez, J. Comín Colet, F. Formiga, et al.
Consenso para la mejora de la atención integral a los pacientes con insuficiencia cardiaca aguda.
Emergencias., 27 (2015), pp. 245-266
W.B. Kannel.
Epidemiology of heart failure.
Am Heart J., 121 (1991), pp. 951-957
M. Anguita Sánchez, M.G. Crespo Leiro, E. de Teresa Galván, M. Jiménez Navarro, L. Alonso-Pulpón, J. Muñiz García.
Prevalence of heart failure in the Spanish general population aged over 45 years. The PRICE Study.
Rev Esp Cardiol., 61 (2008), pp. 1041-1049
P. Llorens, R. Escoda, O. Miró, P. Herrero-Puente, F.J. Martín-Sánchez, J. Jacob, et al.
Características clínicas, terapéuticas y evolutivas de los pacientes con insuficiencia cardiaca aguda atendidos en servicios de urgencias españoles: registro EAHFE (Epidemiology of Acute Heart Failure in Spanish Emergency Departments).
Emergencias., 27 (2015), pp. 11-22
G.A. Bleumink, A.M. Knetsch, M.C. Sturkenboon, S.M. Straus, A. Hofman, J.W. Deckers, et al.
Quantifying the heart failure epidemic: prevalence, incidence rat, lifetime risk, and prognosis of heart failure: The Rotterdam Study.
Eur Heart J., 25 (2004), pp. 1614-1619
M. Schaufelberger, K. Swedberg, M. Köster, M. Rosén, A. Rosengren.
Decreasing one year mortality and hospitalization rates for heart failure in Sweden. Data from the Swedish Hospital Discharge Registry 1988 to 2000.
Eur Heart J., 25 (2004), pp. 300-307
J.M. Ribera Casado.
Insuficiencia cardiaca y hospitalización ¿Son los mismos pacientes?.
Rev Clin Esp., 206 (2006), pp. 60-61
Copyright © 2015. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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