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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acute heart failure &#40;HF&#41; is one of the main reasons for hospitalization for patients older than 65 years and has a direct effect on patient mortality and quality of life&#44; as well as on healthcare costs&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> Reports have also indicated that 1 of every 4 patients hospitalized for HF are readmitted in the first month after the hospital discharge&#44; which could be partly related to insufficient decongestion during the hospitalization and to early discharge&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a> In fact&#44; most patients with decompensated HF still have residual congestion 7 days after the hospitalization&#44; a fact that is associated with higher rehospitalization and mortality rates&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Reducing congestive symptoms in patients with HF through appropriate diuretic therapy is therefore essential&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> In daily clinical practice&#44; however&#44; questions frequently arise as to the appropriate intensity of the diuretic therapy in particular patients&#44; especially since intensive diuretic therapy is sometimes associated with certain renal function impairment&#44; which can motivate physicians to decrease the therapy&#39;s intensity&#46; Accordingly&#44; we need to find surrogate parameters that indicate whether the decongestive therapy is truly effective in patients with acute HF&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a> One of the proposed markers is the degree of hemoconcentration as the result of intensive diuretic therapy&#44; which decreases the electrolyte content of the intravascular space&#44; to a greater degree than the displacement of interstitial fluid to this space&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> Hemoconcentration is therefore an indirect sign of intensive diuretic therapy&#46; Several studies have shown that patients hospitalized for acute HF who have a higher hemoconcentration are administered a higher dosage of diuretics and have greater weight loss during the hospitalization&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> Although studies have observed that patients with acute HF and a higher hemoconcentration associated with intensive diuretic therapy can present renal function impairment&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6&#8211;9</span></a> the impairment is not associated with a greater risk of cardiovascular complications&#46; A number of authors therefore talk of &#8220;pseudo-worsening&#8221; renal function&#44; rather than actual worsening with prognostic consequences&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> In fact&#44; most studies have shown that the hemoconcentration associated with intensive diuretic therapy&#44; during the hospitalization of patients with acute HF&#44; is associated with lower mortality and risk of readmissions for HF&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6&#8211;10</span></a> However&#44; we need to establish criteria that define hemoconcentration and its prognostic utility&#44; according to certain variables&#44; such as the patient&#39;s clinical profile&#44; status at admission and other parameters with prognostic implications such as hyponatremia&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6&#8211;11</span></a> In any case&#44; the lack of this hemoconcentration during hospitalization signals inadequate diuretic therapy&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a> necessitating the search for alternatives to optimize the diuretic therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The study by Grau Amor&#243;s et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a> sought to increase our understanding of hemoconcentration as a predictor for patients with acute HF&#44; analyzing the prognostic value&#44; degree of hemoconcentration at 3 months of discharge for acute HF both in terms of mortality and readmissions for HF during 1 year of follow-up after the discharge&#46; To this end&#44; the authors analyzed a wide sample of patients hospitalized for acute HF in hospitals throughout Spain&#46; Although this study had a tendency towards lower mortality and fewer readmissions for HF in the patients with increased hemoconcentration&#44; the trend was not statistically significant&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Accordingly&#44; it is apparent that greater decongestion during hospitalization&#44; manifested by hemoconcentration&#44; is associated with a better prognosis&#46; However&#44; as the decongestion decreases&#44; the predictive capacity of hemoconcentration decreases&#46; Moreover&#44; certain renal function impairment during hospitalization should not limit the intensive diuretic therapy if the patient requires the therapy&#46; Although hemoconcentration is an easy parameter to measure&#44; there are still several issues that need more research&#44; such as the definition of hemoconcentration itself&#44; at what point during the admission&#47;early discharge should it be measured&#44; should it be considered differently depending on the type of HF &#40;reduced vs&#46; preserved ejection fraction&#41;&#44; and how should patient follow-up be conducted after discharge &#40;frequency of visits and intensification of diuretic therapy&#41;&#44; according to the level of hemoconcentration achieved during the hospitalization&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In short and despite the fact that future studies should clarify these issues&#44; it seems at this time that hemoconcentration during hospitalization and during the first days after the discharge is a simple parameter to measure&#44; and all clinicians should consider hemoconcentration when managing patients with HF&#46; The study by Grau et al&#46; suggested that measuring the hemoconcentration during follow-up after hospitalization for HF could have certain usefulness&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Escobar Cervantes C&#46; Hemoconcentraci&#243;n e insuficiencia cardiaca aguda&#44; &#191;un factor predictor emergente o ya consolidado&#63; Rev Clin Esp&#46; 2019&#59;219&#58;32&#8211;33&#46;</p>"
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Editorial
Hemoconcentration and acute heart failure, an emerging predictive factor or already established?
Hemoconcentración e insuficiencia cardiaca aguda, ¿un factor predictor emergente o ya consolidado?
C. Escobar Cervantes
Servicio de Cardiología, Hospital U. la Paz, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acute heart failure &#40;HF&#41; is one of the main reasons for hospitalization for patients older than 65 years and has a direct effect on patient mortality and quality of life&#44; as well as on healthcare costs&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> Reports have also indicated that 1 of every 4 patients hospitalized for HF are readmitted in the first month after the hospital discharge&#44; which could be partly related to insufficient decongestion during the hospitalization and to early discharge&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a> In fact&#44; most patients with decompensated HF still have residual congestion 7 days after the hospitalization&#44; a fact that is associated with higher rehospitalization and mortality rates&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Reducing congestive symptoms in patients with HF through appropriate diuretic therapy is therefore essential&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> In daily clinical practice&#44; however&#44; questions frequently arise as to the appropriate intensity of the diuretic therapy in particular patients&#44; especially since intensive diuretic therapy is sometimes associated with certain renal function impairment&#44; which can motivate physicians to decrease the therapy&#39;s intensity&#46; Accordingly&#44; we need to find surrogate parameters that indicate whether the decongestive therapy is truly effective in patients with acute HF&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a> One of the proposed markers is the degree of hemoconcentration as the result of intensive diuretic therapy&#44; which decreases the electrolyte content of the intravascular space&#44; to a greater degree than the displacement of interstitial fluid to this space&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> Hemoconcentration is therefore an indirect sign of intensive diuretic therapy&#46; Several studies have shown that patients hospitalized for acute HF who have a higher hemoconcentration are administered a higher dosage of diuretics and have greater weight loss during the hospitalization&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> Although studies have observed that patients with acute HF and a higher hemoconcentration associated with intensive diuretic therapy can present renal function impairment&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6&#8211;9</span></a> the impairment is not associated with a greater risk of cardiovascular complications&#46; A number of authors therefore talk of &#8220;pseudo-worsening&#8221; renal function&#44; rather than actual worsening with prognostic consequences&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> In fact&#44; most studies have shown that the hemoconcentration associated with intensive diuretic therapy&#44; during the hospitalization of patients with acute HF&#44; is associated with lower mortality and risk of readmissions for HF&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6&#8211;10</span></a> However&#44; we need to establish criteria that define hemoconcentration and its prognostic utility&#44; according to certain variables&#44; such as the patient&#39;s clinical profile&#44; status at admission and other parameters with prognostic implications such as hyponatremia&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6&#8211;11</span></a> In any case&#44; the lack of this hemoconcentration during hospitalization signals inadequate diuretic therapy&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a> necessitating the search for alternatives to optimize the diuretic therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The study by Grau Amor&#243;s et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a> sought to increase our understanding of hemoconcentration as a predictor for patients with acute HF&#44; analyzing the prognostic value&#44; degree of hemoconcentration at 3 months of discharge for acute HF both in terms of mortality and readmissions for HF during 1 year of follow-up after the discharge&#46; To this end&#44; the authors analyzed a wide sample of patients hospitalized for acute HF in hospitals throughout Spain&#46; Although this study had a tendency towards lower mortality and fewer readmissions for HF in the patients with increased hemoconcentration&#44; the trend was not statistically significant&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Accordingly&#44; it is apparent that greater decongestion during hospitalization&#44; manifested by hemoconcentration&#44; is associated with a better prognosis&#46; However&#44; as the decongestion decreases&#44; the predictive capacity of hemoconcentration decreases&#46; Moreover&#44; certain renal function impairment during hospitalization should not limit the intensive diuretic therapy if the patient requires the therapy&#46; Although hemoconcentration is an easy parameter to measure&#44; there are still several issues that need more research&#44; such as the definition of hemoconcentration itself&#44; at what point during the admission&#47;early discharge should it be measured&#44; should it be considered differently depending on the type of HF &#40;reduced vs&#46; preserved ejection fraction&#41;&#44; and how should patient follow-up be conducted after discharge &#40;frequency of visits and intensification of diuretic therapy&#41;&#44; according to the level of hemoconcentration achieved during the hospitalization&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In short and despite the fact that future studies should clarify these issues&#44; it seems at this time that hemoconcentration during hospitalization and during the first days after the discharge is a simple parameter to measure&#44; and all clinicians should consider hemoconcentration when managing patients with HF&#46; The study by Grau et al&#46; suggested that measuring the hemoconcentration during follow-up after hospitalization for HF could have certain usefulness&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Escobar Cervantes C&#46; Hemoconcentraci&#243;n e insuficiencia cardiaca aguda&#44; &#191;un factor predictor emergente o ya consolidado&#63; Rev Clin Esp&#46; 2019&#59;219&#58;32&#8211;33&#46;</p>"
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Article information
ISSN: 22548874
Original language: English
DOI:10.1016/j.rceng.2018.12.006
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