Correspondence
Response to the letter regarding the article “Assessment of clinical and haemodynamic congestion as predictors of mortality in elderly outpatients with heart failure”
Réplica a la carta sobre el artículo «Evaluación del grado de congestión clínica y hemodinámica como predictores de mortalidad en pacientes ambulatorios con insuficiencia cardíaca de edad avanzada»
P. Gil-Martínez
, J. Curbelo, E. Roy-Vallejo
Corresponding author
Servicio de Medicina Interna, Hospital Universitario de la Princesa, Grupo de Trabajo de Insuficiencia Cardiaca de la Sociedad Española de Medicina Interna, Fundación Investigación Biosanitaria del Hospital de la Princesa, Madrid, Spain
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Gil-Martínez, J. Curbelo, E. Roy-Vallejo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Gil-Martínez" "email" => array:1 [ 0 => "pgmart@yahoo.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Curbelo" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Roy-Vallejo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario de la Princesa, Grupo de Trabajo de Insuficiencia Cardiaca de la Sociedad Española de Medicina Interna, Fundación Investigación Biosanitaria del Hospital de la Princesa, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Réplica a la carta sobre el artículo «Evaluación del grado de congestión clínica y hemodinámica como predictores de mortalidad en pacientes ambulatorios con insuficiencia cardíaca de edad avanzada»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Thank you for the comments on our work “Assessment of clinical and haemodynamic congestion as predictors of mortality in elderly outpatients with heart failure”.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Congestion is indeed almost universally present in acute heart failure (HF), though its identification as a prognostic factor is relatively recent.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This has encouraged further studies to discover the degree of congestion detected through physical examination, despite the limitations recognised in classic studies, which were mainly conducted in younger male subjects with ischaemic heart disease and ventricular dysfunction.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In the study by Espinosa et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> with 18,120 patients with acute heart failure, the presence of congestive signs/symptoms was associated with greater 30-day mortality. Of the physical signs analysed in our study, peripheral oedema and pulmonary crackles are simple to record, do not take time, and can be examined at any level of care anywhere around the world.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Simultaneously, clinical ultrasound has been introduced to management processes for critical patients and, as such, HF patients. It is also useful for identifying subclinical congestion and has greater diagnostic and prognostic value, though it also presents limitations. Clinical guidelines for HF do not include any specific recommendations regarding its use nor the cut-off points of each technique for diagnosis or for validating correct evolution.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Of the different combined scales for estimating prognosis, the suggested MEESSI and HEFESTOS scales have shown their prognostic utility in patients assessed in the emergency department. They do not include any congestion-related variables (either clinical or ultrasound), other than NTproBNP levels in the latter, meaning they do not include the prognostic information added by congestion. The wide range of required parameters can hinder completion and interpretation. Identifying congestive patients as patients with poor prognosis, regardless of the technique used to do so, will help develop new decongestive strategies and, therefore, will help improve the prognosis of our patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carta sobre el artículo «Evaluación del grado de congestión clínica y hemodinámica como predictores de mortalidad en pacientes ambulatorios con insuficiencia cardíaca de edad avanzada»" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Gil-Rodrigo" 1 => "M.J. Luque-Hernández" 2 => "C. Gutiérrez-García" 3 => "C. 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Perloff" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "1989" "volumen" => "261" "paginaInicial" => "884" "paginaFinal" => "888" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2913385" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pronóstico de la insuficiencia cardiaca aguda basado en datos clínicos de congestión" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "B. Espinosa" 1 => "P. Llorens" 2 => "V. Gil" 3 => "X. Rosello" 4 => "J. Jacob" 5 => "P. Herrero" 6 => "en representación del grupo ICA-SEMES" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2022" "volumen" => "222" "paginaInicial" => "321" "paginaFinal" => "331" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.A. Heidenreich" 1 => "B. Bozkurt" 2 => "D. Aguilar" 3 => "L.A. Allen" 4 => "J.J. Byun" 5 => "M.M. Colvin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIR.0000000000001063" "Revista" => array:7 [ "tituloSerie" => "Circulation" "fecha" => "2022" "volumen" => "145" "numero" => "18" "paginaInicial" => "e895" "paginaFinal" => "e1032" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35363499" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000022300000002/v2_202311091405/S2254887423000152/v2_202311091405/en/main.assets" "Apartado" => array:4 [ "identificador" => "71813" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Correspondence" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022300000002/v2_202311091405/S2254887423000152/v2_202311091405/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887423000152?idApp=WRCEE" ]
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