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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Los pacientes con insuficiencia cardiaca &#40;IC&#41; presentan con frecuencia un n&#250;mero significativo de comorbilidades que determinan su presentaci&#243;n cl&#237;nica y su pron&#243;stico y condicionan su manejo terap&#233;utico&#46; Entre las patolog&#237;as asociadas tienen especial relevancia las enfermedades broncopulmonares&#44; como la enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41; y el asma bronquial&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En torno al 20&#37; de los pacientes con IC podr&#237;an presentar EPOC<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;2</span></a>&#44; cuya prevalencia se incrementa con la edad&#46; La coexistencia de EPOC e IC entra&#241;a una dificultad diagn&#243;stica&#44; dado que suele existir solapamiento en la presentaci&#243;n cl&#237;nica de ambas entidades&#44; a la vez que un reto terap&#233;utico<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a>&#46; La presencia de EPOC en el paciente con IC se asocia a una sintomatolog&#237;a m&#225;s acusada&#44; dificultades para la optimizaci&#243;n terap&#233;utica y peor pron&#243;stico<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En los pacientes con IC&#44; la prevalencia de asma bronquial es inferior a la de EPOC&#44; pero&#44; aun as&#237;&#44; puede superar el 5&#37;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; En estos individuos&#44; la presencia de asma bronquial se ha asociado con un menor uso de betabloqueantes<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">5&#44;6</span></a>&#44; si bien su posible impacto pron&#243;stico no est&#225; claro&#44; ya que hay pocos estudios publicados y sus resultados son contradictorios<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">5&#44;6</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La mayor parte de la informaci&#243;n publicada acerca de las implicaciones cl&#237;nicas y pron&#243;sticas de la patolog&#237;a broncopulmonar en pacientes con IC procede de estudios poblacionales en los que el seguimiento cl&#237;nico y el manejo terap&#233;utico son heterog&#233;neos&#46; Sin embargo&#44; cabr&#237;a pensar que el impacto desfavorable de estas patolog&#237;as asociadas podr&#237;a reducirse en un contexto asistencial especializado&#46; El objetivo de nuestro estudio fue evaluar la repercusi&#243;n de la EPOC y el asma bronquial sobre la optimizaci&#243;n terap&#233;utica y el pron&#243;stico de los pacientes con IC seguidos y tratados en una unidad de IC de Cardiolog&#237;a&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Descripci&#243;n del estudio</span><p id="par0030" class="elsevierStylePara elsevierViewall">Hemos realizado un estudio observacional retrospectivo basado en la cohorte hist&#243;rica de pacientes con diagn&#243;stico previo de IC remitidos entre enero de 2010 y junio de 2022 a la unidad de IC del Servicio de Cardiolog&#237;a del Complejo Hospitalario Universitario de A Coru&#241;a&#46; El protocolo asistencial y los resultados de nuestro programa se han presentado anteriormente<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">7&#44;8</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La informaci&#243;n que se presenta en este manuscrito se obtuvo a partir de la herramienta inform&#225;tica SiMon&#174;&#44; gestor de historias cl&#237;nicas desarrollado en nuestra instituci&#243;n&#46; Esta aplicaci&#243;n incluye un registro de datos de los pacientes con IC remitidos a nuestra unidad que se actualiza peri&#243;dicamente de forma prospectiva por personal de apoyo a la investigaci&#243;n&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El protocolo del estudio fue aprobado por el Comit&#233; de &#201;tica en la Investigaci&#243;n Cl&#237;nica de A Coru&#241;a-Ferrol&#46; Se solicit&#243; el consentimiento informado del paciente para su inclusi&#243;n en el registro&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables</span><p id="par0045" class="elsevierStylePara elsevierViewall">Para el presente estudio&#44; extrajimos informaci&#243;n relativa a variables cl&#237;nicas&#44; estudios complementarios&#44; manejo terap&#233;utico y desenlaces cl&#237;nicos adversos durante el seguimiento&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Los diagn&#243;sticos de asma bronquial o EPOC se consideraron si constaban en la historia cl&#237;nica del paciente&#46; No se realiz&#243; una reclasificaci&#243;n diagn&#243;stica <span class="elsevierStyleItalic">a posteriori</span> ni se solicitaron estudios complementarios adicionales para buscar de forma activa la patolog&#237;a broncopulmonar&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Seguimiento y desenlaces cl&#237;nicos adversos</span><p id="par0055" class="elsevierStylePara elsevierViewall">El seguimiento de los pacientes comprendi&#243; desde la primera visita en la unidad de IC hasta la fecha de muerte o de trasplante cardiaco o&#44; en su defecto&#44; hasta junio de 2023&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Como desenlaces cl&#237;nicos adversos se consideraron la mortalidad por cualquier causa y los desenlaces combinados muerte por cualquier causa u hospitalizaci&#243;n por IC y muerte por causa cardiovascular o trasplante cardiaco&#46; Para el an&#225;lisis del desenlace combinado muerte por cualquier causa u hospitalizaci&#243;n por IC&#44; la hospitalizaci&#243;n para realizar un trasplante cardiaco se contabiliz&#243; como un episodio de hospitalizaci&#243;n por IC&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lisis estad&#237;stico</span><p id="par0065" class="elsevierStylePara elsevierViewall">Las variables categ&#243;ricas se presentan mediante proporciones y las variables continuas se presentan mediante la media y la desviaci&#243;n est&#225;ndar&#46; Utilizamos la prueba chi-cuadrado para comparar variables categ&#243;ricas entre grupos y las pruebas t de Student&#44; an&#225;lisis de la varianza y Kruskal-Wallis&#44; seg&#250;n correspondiese&#44; para comparar variables cuantitativas&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El tiempo hasta los diferentes desenlaces cl&#237;nicos adversos evaluados en el estudio se analiz&#243; mediante el m&#233;todo de Kaplan-Meier&#44; mientras que su comparaci&#243;n univariante entre grupos se realiz&#243; mediante la prueba de rangos logar&#237;tmicos&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Empleamos la regresi&#243;n de Cox multivariante para controlar el efecto de potenciales factores de confusi&#243;n sobre la asociaci&#243;n estad&#237;stica existente entre la presencia de EPOC o asma bronquial y la incidencia de los desenlaces cl&#237;nicos adversos evaluados en el estudio&#46; No se consideraron para el an&#225;lisis multivariante las variables con &#62;<span class="elsevierStyleHsp" style=""></span>10&#37; de valores perdidos&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Se plante&#243; un an&#225;lisis multivariante por pasos hacia atr&#225;s con un criterio de salida p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05 en cuya primera etapa se incluyeron las covariables consideradas potenciales factores de confusi&#243;n en base a su conocida asociaci&#243;n con el pron&#243;stico de los pacientes con IC y&#47;o su distribuci&#243;n asim&#233;trica entre los subgrupos de pacientes con EPOC&#44; asma bronquial o ausencia de broncopat&#237;a&#58; a&#241;o de primera consulta&#44; tiempo desde el diagn&#243;stico de IC&#44; edad&#44; sexo&#44; hipertensi&#243;n arterial&#44; diabetes mellitus&#44; tabaquismo&#44; consumo excesivo de alcohol &#40;&#62;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>g&#47;d&#237;a&#41;&#44; ingreso previo por IC&#44; cardiopat&#237;a isqu&#233;mica&#44; neoplasia previa&#44; arteriopat&#237;a perif&#233;rica&#44; desfibrilador implantable&#44; clase funcional de la <span class="elsevierStyleItalic">New York Heart Association</span> &#40;NYHA&#41;&#44; signos de congesti&#243;n&#44; hemoglobina&#44; bilirrubina&#44; NT-proBNP&#44; ritmo cardiaco&#44; presi&#243;n arterial sist&#243;lica&#44; fracci&#243;n de eyecci&#243;n del ventr&#237;culo izquierdo &#40;FEVI&#41;&#44; tasa de filtrado glomerular&#44; uso de betabloqueantes&#44; uso de antagonistas del receptor mineralcorticoide&#44; uso de inhibidores del sistema renina-angiotensina-aldosterona&#44; uso de inhibidores del cotransportador sodio-glucosa tipo<span class="elsevierStyleHsp" style=""></span>2&#44; uso de diur&#233;tico de asa&#46; Los modelos finales resultantes de este proceso de selecci&#243;n por pasos hacia atr&#225;s se utilizaron para estimar los <span class="elsevierStyleItalic">Hazard ratio</span> &#40;HR&#41; para cada uno de los desenlaces cl&#237;nicos adversos evaluados en pacientes con EPOC y en pacientes con asma bronquial&#44; en comparaci&#243;n con la categor&#237;a de referencia de pacientes sin broncopat&#237;a&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se realiz&#243; con SPSS 25&#46; Se fij&#243; un nivel de significaci&#243;n de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 para todos los contrastes&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Poblaci&#243;n del estudio</span><p id="par0090" class="elsevierStylePara elsevierViewall">La muestra estudiada incluy&#243; a 2&#46;577 pacientes con diagn&#243;stico de IC remitidos de forma consecutiva a nuestra unidad entre enero de 2010 y junio de 2022&#46; De ellos&#44; 698 &#40;27&#44;1&#37;&#41; eran mujeres&#46; La edad media de la muestra era de 63&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;1<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; En total&#44; 1&#46;935 &#40;75&#44;1&#37;&#41; pacientes presentaban una FEVI &#8804;<span class="elsevierStyleHsp" style=""></span>40&#37;&#44; 295 &#40;11&#44;4&#37;&#41; presentaban una FEVI de 41-49&#37; y 329 &#40;12&#44;8&#37;&#41; presentaban una FEVI &#8805;<span class="elsevierStyleHsp" style=""></span>50&#37;&#46; Mil treinta y nueve &#40;40&#44;3&#37;&#41; pacientes hab&#237;an requerido alguna hospitalizaci&#243;n previa por IC&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En la primera visita&#44; 251 &#40;9&#44;7&#37;&#44; intervalo de confianza &#91;IC&#93; al 95&#37;&#58; 8&#44;6&#37;-10&#44;9&#37;&#41; pacientes con IC presentaban adem&#225;s un diagn&#243;stico previo de EPOC y 96 &#40;3&#44;7&#37;&#44; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 3&#37;-4&#44;5&#37;&#41; presentaban un diagn&#243;stico previo de asma bronquial&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Caracter&#237;sticas cl&#237;nicas</span><p id="par0100" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> muestra una comparaci&#243;n de las caracter&#237;sticas cl&#237;nicas basales de los pacientes del estudio&#44; categorizados en tres grupos en funci&#243;n de la presencia de EPOC&#44; asma bronquial o ausencia de patolog&#237;a broncopulmonar&#46; Puede observarse que exist&#237;an diferencias significativas entre los grupos a estudio en relaci&#243;n con numerosas variables cl&#237;nicas de inter&#233;s&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Los pacientes con EPOC presentaban una prevalencia mayor de tabaquismo&#44; consumo de alcohol&#44; hospitalizaci&#243;n previa por IC y arteriopat&#237;a perif&#233;rica&#44; as&#237; como una edad media m&#225;s alta y un tiempo medio de evoluci&#243;n de IC m&#225;s largo&#46; El grupo de pacientes con asma bronquial presentaban una mayor prevalencia de sexo femenino y una menor prevalencia de cardiopat&#237;a isqu&#233;mica e infarto de miocardio&#59; en este grupo se observaba adem&#225;s la mayor proporci&#243;n de pacientes remitidos a la unidad de IC en la era m&#225;s reciente &#40;a&#241;os 2018 a 2022&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Los grupos de pacientes con EPOC o asma bronquial mostraban una mayor prevalencia de clase funcional de la NYHA III o<span class="elsevierStyleHsp" style=""></span>IV y signos de congesti&#243;n&#46; Adem&#225;s&#44; el grupo de pacientes con EPOC presentaban la mayor frecuencia cardiaca basal media&#44; la mayor prevalencia de fibrilaci&#243;n o flutter auricular y trastornos de conducci&#243;n intraventricular y la mayor duraci&#243;n media del complejo QRS de los tres grupos a estudio&#44; as&#237; como la menor tasa de filtrado glomerular y los mayores niveles plasm&#225;ticos de &#225;cido &#250;rico&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">La FEVI media fue similar en los pacientes con EPOC&#44; asma o ausencia de patolog&#237;a broncopulmonar cr&#243;nica&#46; La FEVI era &#8804;<span class="elsevierStyleHsp" style=""></span>40&#37; en 68 &#40;70&#44;8&#37;&#41; pacientes con asma&#44; 194 &#40;77&#44;3&#37;&#41; pacientes con EPOC y 1&#46;678 &#40;75&#44;2&#37;&#41; pacientes sin broncopat&#237;a &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;505&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Manejo terap&#233;utico</span><p id="par0120" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se describe el tratamiento farmacol&#243;gico y la terapia con dispositivos implantables en los tres grupos a estudio&#44; tanto en la primera visita como durante el seguimiento en la unidad de IC&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">En la primera visita&#44; el grupo de pacientes sin broncopat&#237;a presentaban las mayores tasas de prescripci&#243;n de betabloqueantes &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e implante previo de desfibrilador &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;011&#41; de los tres grupos a estudio&#44; sin diferencias significativas con respecto a otros tratamientos&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Durante el seguimiento en la unidad de IC&#44; se prescribieron betabloqueantes en 2098 &#40;94&#44;1&#37;&#41; pacientes sin broncopat&#237;a&#44; en 225 &#40;89&#44;6&#37;&#41; pacientes con EPOC y en 84 &#40;87&#44;5&#37;&#41; pacientes con asma bronquial &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; Se prescribieron inhibidores del cotransportador de sodio-glucosa tipo<span class="elsevierStyleHsp" style=""></span>2 en 854 pacientes &#40;38&#44;3&#37;&#41; sin broncopat&#237;a&#44; en 88 &#40;35&#44;1&#37;&#41; pacientes con EPOC y en 48 &#40;50&#37;&#41; pacientes con asma &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;036&#41;&#46; No se observaron diferencias significativas entre los grupos en relaci&#243;n con otras prescripciones&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En total&#44; 647 &#40;29&#44;0&#37;&#41; pacientes sin broncopat&#237;a&#44; 51 &#40;20&#44;3&#37;&#41; pacientes con EPOC y 20 &#40;20&#44;8&#37;&#41; pacientes con asma bronquial portaron un desfibrilador durante el seguimiento &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; mientras que 199 &#40;8&#44;9&#37;&#41; pacientes sin broncopat&#237;a&#44; 15 &#40;6&#44;0&#37;&#41; pacientes con EPOC y 6 &#40;6&#44;3&#37;&#41; pacientes con asma bronquial portaron un resincronizador &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;204&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Seguimiento y desenlaces cl&#237;nicos adversos</span><p id="par0140" class="elsevierStylePara elsevierViewall">Los pacientes se siguieron durante una mediana de tiempo de 1&#46;493 d&#237;as &#40;rango intercuart&#237;lico 752-2&#46;585 d&#237;as&#41;&#46; Durante este periodo fallecieron 777 &#40;30&#44;1&#37;&#41; pacientes y 155 &#40;6&#37;&#41; recibieron un trasplante cardiaco&#46; Adem&#225;s&#44; 830 &#40;32&#44;2&#37;&#41; pacientes precisaron alguna hospitalizaci&#243;n por IC&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> muestra las curvas de Kaplan-Meier para la probabilidad acumulada de supervivencia &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41;&#44; supervivencia libre de hospitalizaci&#243;n por IC &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41; y muerte por causa cardiovascular o trasplante cardiaco &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>C&#41; en los pacientes con EPOC&#44; asma bronquial o ausencia de broncopat&#237;a&#46; Para los tres desenlaces analizados&#44; la prueba de rangos logar&#237;tmicos mostr&#243; un resultado significativamente peor en el grupo de pacientes con EPOC en comparaci&#243;n con el grupo de pacientes sin broncopat&#237;a &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 para los tres desenlaces&#41;&#44; sin diferencias significativas entre el grupo de pacientes con asma bronquial y el grupo de pacientes sin broncopat&#237;a &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05 para los tres desenlaces&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">An&#225;lisis multivariante</span><p id="par0150" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> muestra un resumen de los HR estimados mediante el m&#233;todo de regresi&#243;n multivariante de Cox para cada uno de los tres desenlaces cl&#237;nicos adversos evaluados en el estudio&#44; en pacientes con EPOC o asma&#44; en comparaci&#243;n con el grupo de referencia de pacientes sin broncopat&#237;a&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">La presencia de EPOC se asoci&#243; de forma independiente con un incremento significativo del riesgo de muerte por cualquier causa &#40;HR ajustado<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;64&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;33-2&#44;02&#41;&#44; muerte por cualquier causa u hospitalizaci&#243;n por IC &#40;HR ajustado<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;47&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;22-1&#44;76&#41; y muerte cardiovascular o trasplante cardiaco &#40;HR ajustado<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;39&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;08-1&#44;79&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">La presencia de asma bronquial no mostr&#243; un impacto significativo sobre el riesgo de ninguno de los tres eventos adversos analizados &#40;HR para muerte por cualquier causa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;98&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;63-1&#44;53&#59; HR para muerte u hospitalizaci&#243;n por IC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;72-1&#44;39&#59; HR para muerte cardiovascular o trasplante cardiaco<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;36&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;88-2&#44;11&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Causas de muerte</span><p id="par0165" class="elsevierStylePara elsevierViewall">Durante el seguimiento fallecieron 127 &#40;50&#44;6&#37;&#41; pacientes con EPOC&#44; 22 &#40;22&#44;9&#37;&#41; pacientes con asma bronquial y 628 &#40;28&#44;2&#37;&#41; pacientes sin broncopat&#237;a&#46; En todos los casos fue posible identificar una causa de muerte&#44; salvo en 1 &#40;0&#44;8&#37;&#41; muerte de pacientes con EPOC y en 13 &#40;2&#44;1&#37;&#41; muertes de pacientes sin broncopat&#237;a&#46; La relaci&#243;n de causas de muerte en cada grupo se representa en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">Las causas de muerte cardiovasculares&#44; en especial la IC y la muerte s&#250;bita&#44; fueron las m&#225;s frecuentes en los tres grupos&#44; ya que justificaron 75 &#40;59&#44;1&#37;&#41; de las muertes en pacientes con EPOC&#44; 15 &#40;68&#44;1&#37;&#41; de las muertes en pacientes con asma bronquial y 394 &#40;62&#44;7&#37;&#41; de las muertes en pacientes sin broncopat&#237;a&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discusi&#243;n</span><p id="par0175" class="elsevierStylePara elsevierViewall">En este trabajo hemos analizado la prevalencia y la repercusi&#243;n pron&#243;stica de la EPOC y el asma bronquial en una cohorte prospectiva de pacientes con IC remitidos a una unidad cl&#237;nica especializada de Cardiolog&#237;a entre enero de 2010 y junio de 2022&#46; Nuestros resultados indican que ambas patolog&#237;as son relativamente frecuentes en estos individuos y que su presencia se asocia a algunas diferencias en su perfil cl&#237;nico&#44; manejo terap&#233;utico y pron&#243;stico&#46; La presencia de EPOC se asoci&#243; de forma independiente con una menor supervivencia&#44; mientras que la presencia de asma bronquial no mostr&#243; un impacto pron&#243;stico significativo&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">En poblaciones no seleccionadas de pacientes con IC la prevalencia de EPOC ronda el 20&#37;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;2</span></a>&#44; mientras que la prevalencia de asma bronquial puede superar el 5&#37;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Sin embargo&#44; en nuestro estudio&#44; basado en una cohorte de pacientes con IC remitidos a una unidad especializada de Cardiolog&#237;a&#44; hemos observado una prevalencia de EPOC del 9&#44;7&#37; y una prevalencia de asma bronquial del 3&#44;7&#37;&#46; Esta aparente discordancia en los datos de prevalencia de patolog&#237;a broncopulmonar&#44; especialmente notoria en el caso de la EPOC&#44; puede explicarse por varias razones&#46; En primer lugar&#44; la asignaci&#243;n de los diagn&#243;sticos de EPOC o asma bronquial en nuestro estudio se hizo en base a su presencia en la historia cl&#237;nica del paciente&#44; sin una estrategia de b&#250;squeda activa de dichas patolog&#237;as&#46; Es posible&#44; por tanto&#44; que una parte de los casos m&#225;s leves hayan pasado inadvertidos&#46; En segundo lugar&#44; nuestro estudio presenta un sesgo de selecci&#243;n derivado del tipo de pacientes que se remiten de modo preferente a los programas de IC de Cardiolog&#237;a&#44; en general m&#225;s j&#243;venes y con menor agregaci&#243;n de comorbilidades que los pacientes con IC atendidos en otros servicios&#44; como Medicina Interna<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">9</span></a>&#46; La sobrerrepresentaci&#243;n del fenotipo de IC y FEVI reducida en nuestra cohorte&#44; tambi&#233;n entre los pacientes con patolog&#237;a broncopulmonar&#44; es otra prueba de ello&#46; Otros autores han observado una elevada prevalencia del fenotipo de IC con FEVI preservada entre los pacientes con asma bronquial<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a> o EPOC<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">En nuestra cohorte&#44; los pacientes con IC y EPOC o asma bronquial presentaban algunas caracter&#237;sticas cl&#237;nicas diferenciales en comparaci&#243;n con los pacientes sin broncopat&#237;a&#46; Al igual que en otras series<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;2</span></a>&#44; los pacientes con EPOC eran m&#225;s frecuentemente varones&#44; presentaban una edad media m&#225;s avanzada y&#44; consecuentemente&#44; mayor tiempo de evoluci&#243;n de la IC en el momento de su primera visita en la consulta especializada&#44; as&#237; como una mayor prevalencia de fibrilaci&#243;n o flutter auricular y una mayor prevalencia de enfermedad arterial coronaria y perif&#233;rica&#44; relacionada con su edad y con su elevada prevalencia de tabaquismo&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Tanto la presencia de EPOC como de asma bronquial se asociaron con clases funcionales de la NYHA m&#225;s avanzadas y con mayor prevalencia de signos f&#237;sicos de congesti&#243;n&#46; Los pacientes con EPOC presentaban otros datos adicionales de gravedad&#44; como una peor funci&#243;n renal&#44; mayores niveles plasm&#225;ticos de &#225;cido &#250;rico&#44; mayor frecuencia cardiaca en reposo&#44; mayor prevalencia de trastornos de conducci&#243;n intraventricular y complejos QRS m&#225;s prolongados&#46; Esta mayor severidad del cuadro cl&#237;nico de IC es concordante con estudios previos&#59; as&#237;&#44; se ha observado que los pacientes con IC y EPOC presentan peores par&#225;metros de rendimiento en la prueba de esfuerzo cardiopulmonar&#44; as&#237; como un remodelo ventricular adverso m&#225;s marcado que los pacientes con IC sin EPOC<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">La infrautilizaci&#243;n de betabloqueantes a los pacientes con IC y EPOC o asma bronquial es una constante en los estudios previos<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;2&#44;5&#44;6</span></a>&#44; y nuestro trabajo no constituye una excepci&#243;n&#46; En nuestra cohorte&#44; la frecuencia de prescripci&#243;n de betabloqueantes en los pacientes con EPOC o asma fue m&#225;s alta que la comunicada por otros autores<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;2&#44;5&#44;6</span></a>&#44; pero&#44; aun as&#237;&#44; fue inferior a la observada en pacientes con IC sin patolog&#237;a broncopulmonar&#46; En estos pacientes&#44; la cautela relativa al empleo de betabloqueantes viene dada por la posibilidad de agravamiento de la patolog&#237;a broncopulmonar&#46; Sin embargo&#44; la evidencia disponible indica que en pacientes con broncopat&#237;a y una indicaci&#243;n cardiovascular consolidada para recibir betabloqueantes los beneficios del tratamiento superan a sus riesgos&#44; ya que este se asocia a una mayor supervivencia<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> e incluso a una menor incidencia de descompensaciones respiratorias<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a>&#46; Por este motivo&#44; la presencia de EPOC o de asma bronquial no se considera actualmente una contraindicaci&#243;n para el inicio de betabloqueantes&#44; preferentemente cardioselectivos&#44; con una observaci&#243;n cl&#237;nica estrecha para anticipar la aparici&#243;n de efectos adversos<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Otro resultado llamativo de nuestro estudio es la mayor prescripci&#243;n relativa de inhibidores del cotransportador de sodio-glucosa tipo<span class="elsevierStyleHsp" style=""></span>2 en pacientes con asma bronquial&#44; que ponemos en relaci&#243;n con la mayor proporci&#243;n relativa de pacientes con asma bronquial que fueron remitidos a la unidad de IC en la era m&#225;s reciente y que&#44; por tanto&#44; tuvieron la oportunidad de recibir este grupo farmacol&#243;gico una vez que su indicaci&#243;n terap&#233;utica se hubo consolidado<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">En nuestro estudio hemos observado una menor frecuencia de implantaci&#243;n de desfibriladores implantables en los pacientes con IC y EPOC o asma en comparaci&#243;n con los pacientes sin patolog&#237;a broncopulmonar&#46; La evidencia disponible avala la eficacia de esta terapia en pacientes con EPOC<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">15</span></a>&#44; pero estos individuos presentan un riesgo incrementado de complicaciones infecciosas<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a> y neumot&#243;rax<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a>&#59; adem&#225;s&#44; la presencia de EPOC se asocia de forma independiente con una menor supervivencia en portadores de desfibrilador<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a>&#46; La aparente infrautilizaci&#243;n de desfibriladores profil&#225;cticos en pacientes con IC y EPOC en nuestro estudio podr&#237;a estar en relaci&#243;n con el diferente perfil cl&#237;nico de este subgrupo&#44; al tratarse de pacientes de mayor edad&#44; con mayor agregaci&#243;n de comorbilidades y una situaci&#243;n de IC m&#225;s avanzada&#44; que resultar&#237;a en una relaci&#243;n riesgo&#47;beneficio menos favorable para la terapia<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">19</span></a>&#46; Menos evidentes resultan las razones que pueden justificar la relativa baja tasa de implante de desfibriladores profil&#225;cticos en pacientes con IC y asma bronquial&#44; resultado que podr&#237;a estar en relaci&#243;n con la menor prevalencia relativa en este subgrupo de pacientes del fenotipo de IC con FEVI reducida&#44; el &#250;nico en el que existe una indicaci&#243;n clara para dicha terapia<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; los pacientes con IC y EPOC presentaron una menor supervivencia global&#44; una menor supervivencia libre de hospitalizaci&#243;n por IC y una mayor incidencia del desenlace combinado muerte cardiovascular o trasplante cardiaco que los pacientes sin patolog&#237;a broncopulmonar&#46; La asociaci&#243;n entre la presencia de EPOC y pron&#243;stico adverso se mantuvo en los modelos multivariantes dise&#241;ados para controlar posibles sesgos de confusi&#243;n derivados de diferencias en el perfil cl&#237;nico y en el tratamiento de estos pacientes&#44; lo que apoya que la EPOC es un verdadero factor pron&#243;stico independiente en esta poblaci&#243;n&#46; Otros autores han identificado asociaciones similares entre la presencia de EPOC y un incremento del riesgo de muerte por cualquier causa<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;2&#44;5&#44;20</span></a>&#44; muerte por causas cardiovasculares<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;20</span></a> y hospitalizaciones por IC<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Cabe destacar que&#44; al igual que en los pacientes sin patolog&#237;a broncopulmonar&#44; en los pacientes con IC y EPOC de nuestra cohorte predominaron las causas cardiovasculares de muerte&#44; en especial la IC refractaria y la muerte s&#250;bita&#44; mientras que las causas no cardiovasculares&#44; como infecciones y neoplasias&#44; fueron minoritarias&#46; En conjunto&#44; nuestros resultados sugieren que&#44; en pacientes con IC&#44; la coexistencia de EPOC no solo dificulta la optimizaci&#243;n terap&#233;utica&#44; sino que puede contribuir a que la propia IC evolucione de forma desfavorable&#46; Existe&#44; adem&#225;s&#44; una base fisiopatol&#243;gica que sustenta esta hip&#243;tesis<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a>&#44; ya que se conoce que la disfunci&#243;n ventilatoria&#44; las alteraciones del intercambio gaseoso y la hiperinsuflaci&#243;n pulmonar propias de la EPOC inducen cambios patol&#243;gicos en la morfolog&#237;a y el tama&#241;o de las c&#225;maras cardiacas&#44; hipertrofia y remodelado exc&#233;ntrico ventricular&#44; favoreciendo la aparici&#243;n de alteraciones hemodin&#225;micas&#44; como reducci&#243;n del volumen de eyecci&#243;n y del gasto cardiaco&#44; incremento de la rigidez arterial sist&#233;mica y pulmonar y&#44; en estadios avanzados&#44; fracaso ventricular derecho&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Nuestro estudio no ha demostrado una asociaci&#243;n significativa entre la presencia de asma bronquial y el pron&#243;stico de los pacientes con IC&#46; Tanto en los an&#225;lisis no ajustados como en los an&#225;lisis ajustados&#44; los pacientes con IC y asma bronquial presentaron una supervivencia global&#44; una supervivencia libre de ingreso por IC y una incidencia del desenlace combinado muerte cardiovascular o trasplante cardiaco comparables a las de los pacientes sin patolog&#237;a broncopulmonar&#46; En un peque&#241;o estudio japon&#233;s basado en una cohorte de 191 pacientes con IC y ausencia de EPOC&#44; con un perfil cl&#237;nico diferente al de nuestra cohorte&#44; con una alta prevalencia de IC con FEVI preservada y una baja tasa de prescripci&#243;n de betabloqueantes&#44; la presencia de asma bronquial s&#237; se asoci&#243; a un incremento de la mortalidad por todas las causas<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a>&#46; Sin embargo&#44; en una gran cohorte de m&#225;s de 200&#46;000 pacientes hospitalizados por IC en Inglaterra y Gales &#250;nicamente la presencia de EPOC&#44; pero no la presencia de asma&#44; se asoci&#243; con un incremento de la mortalidad intrahospitalaria<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a>&#46; M&#225;s all&#225; de sus potenciales implicaciones sobre la optimizaci&#243;n terap&#233;utica&#44; es posible que la ausencia de una clara repercusi&#243;n del asma bronquial en el pron&#243;stico de los pacientes con IC se deba a su car&#225;cter epis&#243;dico y a su limitado impacto sobre la funci&#243;n cardiovascular<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a>&#46;</p><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Limitaciones</span><p id="par0220" class="elsevierStylePara elsevierViewall">El presente estudio tiene algunas limitaciones&#44; derivadas de su car&#225;cter observacional&#46; El escenario cl&#237;nico en el que se ha realizado el estudio&#44; una unidad de IC&#44; condiciona un probable sesgo de selecci&#243;n derivado del perfil de pacientes que se derivan a estos programas&#44; habitualmente m&#225;s j&#243;venes&#44; con mayor prevalencia de cardiopat&#237;a isqu&#233;mica y FEVI reducida y con menor agregaci&#243;n de comorbilidad que los pacientes de la poblaci&#243;n general con IC&#46; Por este motivo&#44; la validez externa de nuestras observaciones no est&#225; garantizada&#46; Adem&#225;s&#44; los diagn&#243;sticos de EPOC y de asma bronquial se realizaron exclusivamente en base a su constancia en la historia cl&#237;nica del paciente&#44; sin replantearlos <span class="elsevierStyleItalic">a posteriori</span> ni realizar una b&#250;squeda activa de los mismos&#46; La fuente de datos utilizada es un registro de pr&#225;ctica cl&#237;nica habitual&#44; no dise&#241;ado de forma dirigida para este estudio&#44; lo que ha condicionado la falta de alguna informaci&#243;n que podr&#237;a resultar de inter&#233;s&#44; como la relativa al tratamiento farmacol&#243;gico de la patolog&#237;a broncopulmonar o a los par&#225;metros de funci&#243;n respiratoria&#46; Por &#250;ltimo&#44; debe reconocerse la posibilidad de sesgos de confusi&#243;n que podr&#237;an persistir pese a los ajustes multivariantes realizados&#44; especialmente en relaci&#243;n con caracter&#237;sticas cl&#237;nicas no medidas&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conclusiones</span><p id="par0225" class="elsevierStylePara elsevierViewall">Nuestro estudio&#44; basado en una cohorte de 2&#46;577 pacientes con IC atendidos en una unidad cl&#237;nica especializada de Cardiolog&#237;a entre enero de 2010 y junio de 2022&#44; constata que la coexistencia de patolog&#237;a broncopulmonar &#40;asma bronquial o EPOC&#41; se asocia a diferencias en el perfil cl&#237;nico&#44; el tratamiento y el pron&#243;stico de estos individuos&#46; En nuestra cohorte&#44; los pacientes con IC y asma bronquial o EPOC recibieron con menos frecuencia tratamiento betabloqueante y desfibriladores profil&#225;cticos que los pacientes sin patolog&#237;a broncopulmonar&#46; La presencia de EPOC&#44; pero no as&#237; la de asma bronquial&#44; se identific&#243; como un predictor independiente de pron&#243;stico adverso&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">En el futuro ser&#225;n necesarios nuevos estudios que permitan profundizar en el conocimiento de los mecanismos fisiopatol&#243;gicos subyacentes en pacientes con IC y patolog&#237;a broncopulmonar para individualizar su manejo cl&#237;nico&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Financiaci&#243;n</span><p id="par0235" class="elsevierStylePara elsevierViewall">Algunos de los autores del manuscrito son miembros del grupo CB16&#47;11&#47;00425 del Centro de Investigaci&#243;n Biom&#233;dica en Red de Enfermedades Cardiovasculares &#40;CIBERCV&#41; del Instituto de Salud Carlos<span class="elsevierStyleHsp" style=""></span>III&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">El estudio no ha contado con otro tipo de financiaci&#243;n espec&#237;fica diferente a la que nuestro grupo recibe anualmente por su participaci&#243;n en dicha red tem&#225;tica&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflicto de intereses</span><p id="par0250" class="elsevierStylePara elsevierViewall">Los autores no declaran conflicto de intereses en relaci&#243;n con esta publicaci&#243;n&#46;</p></span></span>"
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    "fechaRecibido" => "2024-01-03"
    "fechaAceptado" => "2024-01-15"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1792388"
          "palabras" => array:5 [
            0 => "Insuficiencia cardiaca"
            1 => "Pron&#243;stico"
            2 => "Tratamiento"
            3 => "EPOC"
            4 => "Asma"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1792387"
          "palabras" => array:5 [
            0 => "Heart failure"
            1 => "Prognosis"
            2 => "Treatment"
            3 => "COPD"
            4 => "Bronchial asthma"
          ]
        ]
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    "tieneResumen" => true
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Prop&#243;sito</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar el impacto de la enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41; y el asma bronquial sobre el manejo terap&#233;utico y el pron&#243;stico de los pacientes con insuficiencia cardiaca &#40;IC&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis de la informaci&#243;n contenida en un registro cl&#237;nico de pacientes remitidos a una unidad especializada de IC entre enero de 2010 y junio de 2022&#46; Se compararon su perfil cl&#237;nico&#44; el tratamiento y el pron&#243;stico en base a la presencia de EPOC o asma bronquial&#46; El an&#225;lisis de supervivencia se realiz&#243; mediante los m&#233;todos de Kaplan-Meier y Cox&#46; La mediana de seguimiento fue de 1&#46;493 d&#237;as&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron 2&#46;577 pacientes&#44; de los cuales 251 &#40;9&#44;7&#37;&#41; presentaban EPOC y 96 &#40;3&#44;7&#37;&#41;&#44; asma bronquial&#46; Observamos diferencias significativas entre los tres grupos con respecto a la prescripci&#243;n de betabloqueantes &#40;EPOC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>89&#44;6&#37;&#59; asma<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>87&#44;5&#37;&#59; no broncopat&#237;a<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>94&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; e inhibidores del cotransportador de sodio-glucosa tipo<span class="elsevierStyleHsp" style=""></span>2 &#40;EPOC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35&#44;1&#37;&#59; asma<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#37;&#59; no broncopat&#237;a<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;036&#41;&#46; Adem&#225;s&#44; los pacientes con patolog&#237;a bronquial recibieron con menor frecuencia un desfibrilador &#40;EPOC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#44;3&#37;&#59; asma<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#44;8&#37;&#59; no broncopat&#237;a<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La presencia de EPOC se asoci&#243; de forma independiente con mayor riesgo de muerte por cualquier causa &#40;HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;64&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;33-2&#44;02&#41;&#44; muerte u hospitalizaci&#243;n por IC &#40;HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;47&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;22-1&#44;76&#41; y muerte cardiovascular o trasplante cardiaco &#40;HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;39&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;08-1&#44;79&#41; en comparaci&#243;n con la ausencia de broncopat&#237;a&#46; La presencia de asma bronquial no se asoci&#243; a un impacto significativo sobre los desenlaces analizados&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La EPOC&#44; pero no el asma bronquial&#44; es un factor pron&#243;stico adverso e independiente en pacientes con IC&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Prop&#243;sito"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Purpose</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To analyze the impact of chronic obstructive pulmonary disease &#40;COPD&#41; and bronchial asthma on therapeutic management and prognosis of patients with heart failure &#40;HF&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Analysis of the information collected in a clinical registry of patients referred to a specialized HF unit from January-2010 to June-2012&#46; Clinical profile&#44; treatment and prognosis of patients was evaluated&#44; according to the presence of COPD or asthma&#46; Survival analyses were conducted by means of Kaplan-Meier and Cox&#39;s methods&#46; Median follow-up was 1493 days&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We studied 2577 patients&#44; of which 251 &#40;9&#46;7&#37;&#41; presented COPD and 96 &#40;3&#46;7&#37;&#41; bronchial asthma&#46; Significant differences among study groups were observed regarding to the prescription of beta-blockers &#40;COPD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>89&#46;6&#37;&#59; asthma<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>87&#46;5&#37;&#59; no bronchopathy<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>94&#46;1&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41; and SGLT2 inhibitors &#40;COPD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35&#46;1&#37;&#59; asthma<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#37;&#59; no bronchopathy<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#46;3&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;036&#41;&#46; Also&#44; patients with bronchial disease received less frequently a defibrillator &#40;COPD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#46;3&#37;&#59; asthma<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#46;8&#37;&#59; no broncopathy<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41;&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">COPD was independently associated with increased risk of all-cause mortality &#40;HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;64&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;33-2&#46;02&#41;&#44; all-cause death or HF admission &#40;HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;47&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;22-1&#46;76&#41; and cardiovascular death or heart transplantation &#40;HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;39&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;08-1&#46;79&#41; as compared with patients with no bronchopathy&#46; Bronchial asthma was not significantly associated with increased risk of adverse outcomes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">COPD&#44; but not asthma&#44; is an adverse independent prognostic factor in patients with HF&#46;</p></span>"
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            "titulo" => "Purpose"
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            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
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            "identificador" => "abst0040"
            "titulo" => "Conclusions"
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Curvas de Kaplan-Meier para supervivencia global &#40;A&#41;&#44; supervivencia libre de ingreso por insuficiencia cardiaca &#40;B&#41; y probabilidad acumulada de muerte cardiovascular o trasplante cardiaco &#40;C&#41; en los tres grupos a estudio&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">EPOC&#58; enfermedad pulmonar obstructiva cr&#243;nica&#46;</p>"
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n de las causas de muerte durante el seguimiento a largo plazo en los tres grupos a estudio&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">EPOC&#58; enfermedad pulmonar obstructiva cr&#243;nica&#46;</p>"
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        "detalles" => array:1 [
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            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">DDVI&#58; di&#225;metro diast&#243;lico del ventr&#237;culo izquierdo&#59; DSVI&#58; di&#225;metro sist&#243;lico del ventr&#237;culo izquierdo&#59; EPOC&#58; enfermedad pulmonar obstructiva cr&#243;nica&#59; FEVI&#58; fracci&#243;n de eyecci&#243;n del ventr&#237;culo izquierdo&#59; GGT&#58; gamma-glutamil transpeptidasa&#59; GOT&#58; glutamato-oxalato transaminasa&#59; GPT&#58; glutamato-piruvato transaminasa&#59; IC&#58; insuficiencia cardiaca&#59; NT-proBNP&#58; fracci&#243;n N-terminal del prop&#233;ptido natriur&#233;tico cerebral&#59; NYHA&#58; <span class="elsevierStyleItalic">New York Heart Association</span>&#59; PSAP&#58; presi&#243;n sist&#243;lica de arteria pulmonar&#59; TAPSE&#58; distancia de excursi&#243;n sist&#243;lica del anillo tricusp&#237;deo&#59; UI&#58; unidades internacionales&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sin broncopat&#237;a&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2230&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Historia cl&#237;nica previa</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sexo femenino</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">618 &#40;27&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36 &#40;14&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44 &#40;45&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#205;ndice de masa corporal &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;428&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Tiempo desde el diagn&#243;stico de IC</span><span class="elsevierStyleItalic">&#40;d&#237;as&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">952&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;970&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;031&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hospitalizaci&#243;n previa por IC</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">877 &#40;39&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">134 &#40;53&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28 &#40;29&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Consumo de alcohol &#40;&#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">40</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">g&#47;d&#237;a&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">568 &#40;25&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">91 &#40;36&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;18&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;270 &#40;57&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">43 &#40;44&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hipertensi&#243;n arterial</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;187 &#40;53&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">148 &#40;59&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53 &#40;55&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;217&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dislipemia</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;295 &#40;58&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">152 &#40;60&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">62 &#40;64&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;356&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Diabetes mellitus</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">691 &#40;31&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">86 &#40;34&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26 &#40;27&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;386&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cardiopat&#237;a isqu&#233;mica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;050 &#40;47&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">114 &#40;45&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">31 &#40;32&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Infarto de miocardio previo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">719 &#40;32&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">74 &#40;29&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19 &#40;19&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ictus previo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">206 &#40;9&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31 &#40;12&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;7&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;212&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enfermedad arterial perif&#233;rica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">152 &#40;6&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36 &#40;14&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;5&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Neoplasia previa</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">347 &#40;15&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">48 &#40;19&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">19 &#40;19&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;207&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Situaci&#243;n cl&#237;nica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Clase funcional NYHA</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Clase I&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">270 &#40;12&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;3&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;11&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Clase II&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;255 &#40;56&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">142 &#40;56&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44 &#40;45&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Clase III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">640 &#40;28&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">88 &#40;35&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">39 &#40;40&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Clase IV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;2&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">12 &#40;4&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2 &#40;2&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Signos de congesti&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">422 &#40;18&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">61 &#40;24&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">28 &#40;29&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Congesti&#243;n pulmonar</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">249 &#40;11&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">42 &#40;16&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">15 &#40;15&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Congesti&#243;n sist&#233;mica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">330 &#40;14&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">50 &#40;19&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">26 &#40;27&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Frecuencia card&#237;aca &#40;latidos&#47;min&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#44;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">73&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Presi&#243;n arterial sist&#243;lica &#40;mmHg&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">116&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;525&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Presi&#243;n arterial diast&#243;lica &#40;mmHg&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Electrocardiograma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ritmo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;035&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sinusal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;509 &#40;67&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">149 &#40;59&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;72&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Fibrilaci&#243;n o flutter auricular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">611 &#40;27&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79 &#40;31&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;21&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Otro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98 &#40;4&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;8&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;4&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Desconocido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;0&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Trastorno de conducci&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Bloqueo de rama izquierda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">466 &#40;20&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#40;18&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;14&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Bloqueo de rama derecha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">163 &#40;7&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;13&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;3&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Otro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;2&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;2&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;3&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;543 &#40;69&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">163 &#40;64&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Duraci&#243;n del complejo QRS &#40;ms&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ivabradina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32 &#40;12&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;11&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;357&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Desfibrilador autom&#225;tico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">349 &#40;15&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;9&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;9&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Terapia de resincronizaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">71 &#40;3&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;2&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;498&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Seguimiento en la unidad de IC</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Betabloqueante&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;098 &#40;94&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">225 &#40;89&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">84 &#40;87&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antagonista del receptor mineralcorticoide&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;860 &#40;83&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">204 &#40;81&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">83 &#40;86&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;485&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inhibidor del cotransportador de sodio-glucosa tipo<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">854 &#40;38&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">88 &#40;35&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">48 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;036&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inhibidor de la enzima conversora de la angiotensina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;137 &#40;51&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">127 &#40;50&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41 &#40;42&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;283&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antagonista del receptor de angiotensina<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">465 &#40;20&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">54 &#40;21&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;21&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;946&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sacubitril-valsart&#225;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;027 &#40;46&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">106 &#40;42&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">45 &#40;46&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;501&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diur&#233;tico de asa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;891 &#40;84&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">224 &#40;89&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">79 &#40;82&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tiazida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">367 &#40;16&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">48 &#40;19&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">17 &#40;17&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;545&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Digoxina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">289 &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">39 &#40;15&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;16&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;325&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ivabradina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">476 &#40;21&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;24&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;352&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Desfibrilador autom&#225;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">647 &#40;29&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;20&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20 &#40;20&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Terapia de resincronizaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">199 &#40;8&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;6&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;204&nbsp;\t\t\t\t\t\t\n
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            0 => array:3 [
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Tratamiento farmacol&#243;gico e implante de dispositivos endocavitarios en los pacientes del estudio&#44; clasificados en tres grupos en base a la presencia de EPOC&#44; asma o ausencia de broncopat&#237;a&#44; tanto en el momento de la primera visita en la unidad de insuficiencia cardiaca como durante el seguimiento en la misma</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Desenlace cl&#237;nico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EPOC vs&#46; ausencia de broncopat&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;64 &#40;1&#44;33-2&#44;02&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asma bronquial vs&#46; ausencia de broncopat&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Muerte u hospitalizaci&#243;n por IC</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EPOC vs&#46; ausencia de broncopat&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;75 &#40;1&#44;48-2&#44;07&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;47 &#40;1&#44;22-1&#44;76&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asma bronquial vs&#46; ausencia de broncopat&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;72-1&#44;39&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asma bronquial vs&#46; ausencia de broncopat&#237;a&nbsp;\t\t\t\t\t\t\n
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        0 => array:2 [
          "identificador" => "bibs0015"
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            0 => array:3 [
              "identificador" => "bib0115"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and prognostic impact of chronic obstructive pulmonary disease in patients with chronic heart failure&#58; Data from the GISSI-HF trial"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Canepa"
                            1 => "P&#46;L&#46; Temporelli"
                            2 => "A&#46; Rossi"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000448166"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cardiology&#46;"
                        "fecha" => "2017"
                        "volumen" => "136"
                        "paginaInicial" => "128"
                        "paginaFinal" => "137"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27618363"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characteristics&#44; treatments and 1-year prognosis of hospitalized and ambulatory heart failure patients with chronic obstructive pulmonary disease in the European Society of Cardiology Heart Failure Long-Term Registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Canepa"
                            1 => "E&#46; Straburzynska-Migaj"
                            2 => "J&#46; Drozdz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ejhf.964"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Heart Fail&#46;"
                        "fecha" => "2018"
                        "volumen" => "20"
                        "paginaInicial" => "100"
                        "paginaFinal" => "110"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28949063"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            2 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic and therapeutic challenges in patients with coexistent chronic obstructive pulmonary disease and chronic heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;H&#46; Le Jemtel"
                            1 => "M&#46; Padeletti"
                            2 => "S&#46; Jelic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2006.08.046"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2007"
                        "volumen" => "49"
                        "paginaInicial" => "171"
                        "paginaFinal" => "180"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17222727"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic and therapeutic gaps in patients with heart failure and chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Canepa"
                            1 => "F&#46;M&#46;E&#46; Franssen"
                            2 => "H&#46; Olschewski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jchf.2019.05.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "JACC Heart Fail&#46;"
                        "fecha" => "2019"
                        "volumen" => "7"
                        "paginaInicial" => "823"
                        "paginaFinal" => "833"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31521680"
                            "web" => "Medline"
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Original
Impacto pronóstico de la enfermedad pulmonar obstructiva crónica y el asma bronquial en pacientes con insuficiencia cardiaca
Prognostic impact of chronic obstructive pulmonary disease and bronchial asthma in patients with heart failure
E. Barge-Caballeroa,b,
Autor para correspondencia
Eduardo.barge.caballero@sergas.es

Autor para correspondencia.
, J. Sieira-Hermidaa, G. Barge-Caballeroa,b, D. Couto-Mallóna,b, M.J. Paniagua-Martína,b, D. Enríquez-Vázqueza,b, P.J. Marcos-Rodríguezc, J. Rodríguez-Capitánb,d,e, J.M. Vázquez-Rodrígueza,b, M.G. Crespo-Leiroa,b,f
a Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Servicio Galego de Saúde (SERGAS), A Coruña, España
b Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
c Dirección Asistencial y Servicio de Neumología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Servicio Galego de Saúde (SERGAS), A Coruña, España
d Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
e Plataforma en Nanomedicina (IBIMA-Plataforma BIONAND), Universidad de Málaga, Málaga, España
f Universidad de A Coruña (UDC), A Coruña, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Los pacientes con insuficiencia cardiaca &#40;IC&#41; presentan con frecuencia un n&#250;mero significativo de comorbilidades que determinan su presentaci&#243;n cl&#237;nica y su pron&#243;stico y condicionan su manejo terap&#233;utico&#46; Entre las patolog&#237;as asociadas tienen especial relevancia las enfermedades broncopulmonares&#44; como la enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41; y el asma bronquial&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En torno al 20&#37; de los pacientes con IC podr&#237;an presentar EPOC<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;2</span></a>&#44; cuya prevalencia se incrementa con la edad&#46; La coexistencia de EPOC e IC entra&#241;a una dificultad diagn&#243;stica&#44; dado que suele existir solapamiento en la presentaci&#243;n cl&#237;nica de ambas entidades&#44; a la vez que un reto terap&#233;utico<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a>&#46; La presencia de EPOC en el paciente con IC se asocia a una sintomatolog&#237;a m&#225;s acusada&#44; dificultades para la optimizaci&#243;n terap&#233;utica y peor pron&#243;stico<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En los pacientes con IC&#44; la prevalencia de asma bronquial es inferior a la de EPOC&#44; pero&#44; aun as&#237;&#44; puede superar el 5&#37;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; En estos individuos&#44; la presencia de asma bronquial se ha asociado con un menor uso de betabloqueantes<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">5&#44;6</span></a>&#44; si bien su posible impacto pron&#243;stico no est&#225; claro&#44; ya que hay pocos estudios publicados y sus resultados son contradictorios<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">5&#44;6</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La mayor parte de la informaci&#243;n publicada acerca de las implicaciones cl&#237;nicas y pron&#243;sticas de la patolog&#237;a broncopulmonar en pacientes con IC procede de estudios poblacionales en los que el seguimiento cl&#237;nico y el manejo terap&#233;utico son heterog&#233;neos&#46; Sin embargo&#44; cabr&#237;a pensar que el impacto desfavorable de estas patolog&#237;as asociadas podr&#237;a reducirse en un contexto asistencial especializado&#46; El objetivo de nuestro estudio fue evaluar la repercusi&#243;n de la EPOC y el asma bronquial sobre la optimizaci&#243;n terap&#233;utica y el pron&#243;stico de los pacientes con IC seguidos y tratados en una unidad de IC de Cardiolog&#237;a&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Descripci&#243;n del estudio</span><p id="par0030" class="elsevierStylePara elsevierViewall">Hemos realizado un estudio observacional retrospectivo basado en la cohorte hist&#243;rica de pacientes con diagn&#243;stico previo de IC remitidos entre enero de 2010 y junio de 2022 a la unidad de IC del Servicio de Cardiolog&#237;a del Complejo Hospitalario Universitario de A Coru&#241;a&#46; El protocolo asistencial y los resultados de nuestro programa se han presentado anteriormente<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">7&#44;8</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La informaci&#243;n que se presenta en este manuscrito se obtuvo a partir de la herramienta inform&#225;tica SiMon&#174;&#44; gestor de historias cl&#237;nicas desarrollado en nuestra instituci&#243;n&#46; Esta aplicaci&#243;n incluye un registro de datos de los pacientes con IC remitidos a nuestra unidad que se actualiza peri&#243;dicamente de forma prospectiva por personal de apoyo a la investigaci&#243;n&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El protocolo del estudio fue aprobado por el Comit&#233; de &#201;tica en la Investigaci&#243;n Cl&#237;nica de A Coru&#241;a-Ferrol&#46; Se solicit&#243; el consentimiento informado del paciente para su inclusi&#243;n en el registro&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables</span><p id="par0045" class="elsevierStylePara elsevierViewall">Para el presente estudio&#44; extrajimos informaci&#243;n relativa a variables cl&#237;nicas&#44; estudios complementarios&#44; manejo terap&#233;utico y desenlaces cl&#237;nicos adversos durante el seguimiento&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Los diagn&#243;sticos de asma bronquial o EPOC se consideraron si constaban en la historia cl&#237;nica del paciente&#46; No se realiz&#243; una reclasificaci&#243;n diagn&#243;stica <span class="elsevierStyleItalic">a posteriori</span> ni se solicitaron estudios complementarios adicionales para buscar de forma activa la patolog&#237;a broncopulmonar&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Seguimiento y desenlaces cl&#237;nicos adversos</span><p id="par0055" class="elsevierStylePara elsevierViewall">El seguimiento de los pacientes comprendi&#243; desde la primera visita en la unidad de IC hasta la fecha de muerte o de trasplante cardiaco o&#44; en su defecto&#44; hasta junio de 2023&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Como desenlaces cl&#237;nicos adversos se consideraron la mortalidad por cualquier causa y los desenlaces combinados muerte por cualquier causa u hospitalizaci&#243;n por IC y muerte por causa cardiovascular o trasplante cardiaco&#46; Para el an&#225;lisis del desenlace combinado muerte por cualquier causa u hospitalizaci&#243;n por IC&#44; la hospitalizaci&#243;n para realizar un trasplante cardiaco se contabiliz&#243; como un episodio de hospitalizaci&#243;n por IC&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lisis estad&#237;stico</span><p id="par0065" class="elsevierStylePara elsevierViewall">Las variables categ&#243;ricas se presentan mediante proporciones y las variables continuas se presentan mediante la media y la desviaci&#243;n est&#225;ndar&#46; Utilizamos la prueba chi-cuadrado para comparar variables categ&#243;ricas entre grupos y las pruebas t de Student&#44; an&#225;lisis de la varianza y Kruskal-Wallis&#44; seg&#250;n correspondiese&#44; para comparar variables cuantitativas&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El tiempo hasta los diferentes desenlaces cl&#237;nicos adversos evaluados en el estudio se analiz&#243; mediante el m&#233;todo de Kaplan-Meier&#44; mientras que su comparaci&#243;n univariante entre grupos se realiz&#243; mediante la prueba de rangos logar&#237;tmicos&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Empleamos la regresi&#243;n de Cox multivariante para controlar el efecto de potenciales factores de confusi&#243;n sobre la asociaci&#243;n estad&#237;stica existente entre la presencia de EPOC o asma bronquial y la incidencia de los desenlaces cl&#237;nicos adversos evaluados en el estudio&#46; No se consideraron para el an&#225;lisis multivariante las variables con &#62;<span class="elsevierStyleHsp" style=""></span>10&#37; de valores perdidos&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Se plante&#243; un an&#225;lisis multivariante por pasos hacia atr&#225;s con un criterio de salida p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05 en cuya primera etapa se incluyeron las covariables consideradas potenciales factores de confusi&#243;n en base a su conocida asociaci&#243;n con el pron&#243;stico de los pacientes con IC y&#47;o su distribuci&#243;n asim&#233;trica entre los subgrupos de pacientes con EPOC&#44; asma bronquial o ausencia de broncopat&#237;a&#58; a&#241;o de primera consulta&#44; tiempo desde el diagn&#243;stico de IC&#44; edad&#44; sexo&#44; hipertensi&#243;n arterial&#44; diabetes mellitus&#44; tabaquismo&#44; consumo excesivo de alcohol &#40;&#62;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>g&#47;d&#237;a&#41;&#44; ingreso previo por IC&#44; cardiopat&#237;a isqu&#233;mica&#44; neoplasia previa&#44; arteriopat&#237;a perif&#233;rica&#44; desfibrilador implantable&#44; clase funcional de la <span class="elsevierStyleItalic">New York Heart Association</span> &#40;NYHA&#41;&#44; signos de congesti&#243;n&#44; hemoglobina&#44; bilirrubina&#44; NT-proBNP&#44; ritmo cardiaco&#44; presi&#243;n arterial sist&#243;lica&#44; fracci&#243;n de eyecci&#243;n del ventr&#237;culo izquierdo &#40;FEVI&#41;&#44; tasa de filtrado glomerular&#44; uso de betabloqueantes&#44; uso de antagonistas del receptor mineralcorticoide&#44; uso de inhibidores del sistema renina-angiotensina-aldosterona&#44; uso de inhibidores del cotransportador sodio-glucosa tipo<span class="elsevierStyleHsp" style=""></span>2&#44; uso de diur&#233;tico de asa&#46; Los modelos finales resultantes de este proceso de selecci&#243;n por pasos hacia atr&#225;s se utilizaron para estimar los <span class="elsevierStyleItalic">Hazard ratio</span> &#40;HR&#41; para cada uno de los desenlaces cl&#237;nicos adversos evaluados en pacientes con EPOC y en pacientes con asma bronquial&#44; en comparaci&#243;n con la categor&#237;a de referencia de pacientes sin broncopat&#237;a&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se realiz&#243; con SPSS 25&#46; Se fij&#243; un nivel de significaci&#243;n de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 para todos los contrastes&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Poblaci&#243;n del estudio</span><p id="par0090" class="elsevierStylePara elsevierViewall">La muestra estudiada incluy&#243; a 2&#46;577 pacientes con diagn&#243;stico de IC remitidos de forma consecutiva a nuestra unidad entre enero de 2010 y junio de 2022&#46; De ellos&#44; 698 &#40;27&#44;1&#37;&#41; eran mujeres&#46; La edad media de la muestra era de 63&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;1<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; En total&#44; 1&#46;935 &#40;75&#44;1&#37;&#41; pacientes presentaban una FEVI &#8804;<span class="elsevierStyleHsp" style=""></span>40&#37;&#44; 295 &#40;11&#44;4&#37;&#41; presentaban una FEVI de 41-49&#37; y 329 &#40;12&#44;8&#37;&#41; presentaban una FEVI &#8805;<span class="elsevierStyleHsp" style=""></span>50&#37;&#46; Mil treinta y nueve &#40;40&#44;3&#37;&#41; pacientes hab&#237;an requerido alguna hospitalizaci&#243;n previa por IC&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En la primera visita&#44; 251 &#40;9&#44;7&#37;&#44; intervalo de confianza &#91;IC&#93; al 95&#37;&#58; 8&#44;6&#37;-10&#44;9&#37;&#41; pacientes con IC presentaban adem&#225;s un diagn&#243;stico previo de EPOC y 96 &#40;3&#44;7&#37;&#44; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 3&#37;-4&#44;5&#37;&#41; presentaban un diagn&#243;stico previo de asma bronquial&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Caracter&#237;sticas cl&#237;nicas</span><p id="par0100" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> muestra una comparaci&#243;n de las caracter&#237;sticas cl&#237;nicas basales de los pacientes del estudio&#44; categorizados en tres grupos en funci&#243;n de la presencia de EPOC&#44; asma bronquial o ausencia de patolog&#237;a broncopulmonar&#46; Puede observarse que exist&#237;an diferencias significativas entre los grupos a estudio en relaci&#243;n con numerosas variables cl&#237;nicas de inter&#233;s&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Los pacientes con EPOC presentaban una prevalencia mayor de tabaquismo&#44; consumo de alcohol&#44; hospitalizaci&#243;n previa por IC y arteriopat&#237;a perif&#233;rica&#44; as&#237; como una edad media m&#225;s alta y un tiempo medio de evoluci&#243;n de IC m&#225;s largo&#46; El grupo de pacientes con asma bronquial presentaban una mayor prevalencia de sexo femenino y una menor prevalencia de cardiopat&#237;a isqu&#233;mica e infarto de miocardio&#59; en este grupo se observaba adem&#225;s la mayor proporci&#243;n de pacientes remitidos a la unidad de IC en la era m&#225;s reciente &#40;a&#241;os 2018 a 2022&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Los grupos de pacientes con EPOC o asma bronquial mostraban una mayor prevalencia de clase funcional de la NYHA III o<span class="elsevierStyleHsp" style=""></span>IV y signos de congesti&#243;n&#46; Adem&#225;s&#44; el grupo de pacientes con EPOC presentaban la mayor frecuencia cardiaca basal media&#44; la mayor prevalencia de fibrilaci&#243;n o flutter auricular y trastornos de conducci&#243;n intraventricular y la mayor duraci&#243;n media del complejo QRS de los tres grupos a estudio&#44; as&#237; como la menor tasa de filtrado glomerular y los mayores niveles plasm&#225;ticos de &#225;cido &#250;rico&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">La FEVI media fue similar en los pacientes con EPOC&#44; asma o ausencia de patolog&#237;a broncopulmonar cr&#243;nica&#46; La FEVI era &#8804;<span class="elsevierStyleHsp" style=""></span>40&#37; en 68 &#40;70&#44;8&#37;&#41; pacientes con asma&#44; 194 &#40;77&#44;3&#37;&#41; pacientes con EPOC y 1&#46;678 &#40;75&#44;2&#37;&#41; pacientes sin broncopat&#237;a &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;505&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Manejo terap&#233;utico</span><p id="par0120" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se describe el tratamiento farmacol&#243;gico y la terapia con dispositivos implantables en los tres grupos a estudio&#44; tanto en la primera visita como durante el seguimiento en la unidad de IC&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">En la primera visita&#44; el grupo de pacientes sin broncopat&#237;a presentaban las mayores tasas de prescripci&#243;n de betabloqueantes &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e implante previo de desfibrilador &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;011&#41; de los tres grupos a estudio&#44; sin diferencias significativas con respecto a otros tratamientos&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Durante el seguimiento en la unidad de IC&#44; se prescribieron betabloqueantes en 2098 &#40;94&#44;1&#37;&#41; pacientes sin broncopat&#237;a&#44; en 225 &#40;89&#44;6&#37;&#41; pacientes con EPOC y en 84 &#40;87&#44;5&#37;&#41; pacientes con asma bronquial &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; Se prescribieron inhibidores del cotransportador de sodio-glucosa tipo<span class="elsevierStyleHsp" style=""></span>2 en 854 pacientes &#40;38&#44;3&#37;&#41; sin broncopat&#237;a&#44; en 88 &#40;35&#44;1&#37;&#41; pacientes con EPOC y en 48 &#40;50&#37;&#41; pacientes con asma &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;036&#41;&#46; No se observaron diferencias significativas entre los grupos en relaci&#243;n con otras prescripciones&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En total&#44; 647 &#40;29&#44;0&#37;&#41; pacientes sin broncopat&#237;a&#44; 51 &#40;20&#44;3&#37;&#41; pacientes con EPOC y 20 &#40;20&#44;8&#37;&#41; pacientes con asma bronquial portaron un desfibrilador durante el seguimiento &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; mientras que 199 &#40;8&#44;9&#37;&#41; pacientes sin broncopat&#237;a&#44; 15 &#40;6&#44;0&#37;&#41; pacientes con EPOC y 6 &#40;6&#44;3&#37;&#41; pacientes con asma bronquial portaron un resincronizador &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;204&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Seguimiento y desenlaces cl&#237;nicos adversos</span><p id="par0140" class="elsevierStylePara elsevierViewall">Los pacientes se siguieron durante una mediana de tiempo de 1&#46;493 d&#237;as &#40;rango intercuart&#237;lico 752-2&#46;585 d&#237;as&#41;&#46; Durante este periodo fallecieron 777 &#40;30&#44;1&#37;&#41; pacientes y 155 &#40;6&#37;&#41; recibieron un trasplante cardiaco&#46; Adem&#225;s&#44; 830 &#40;32&#44;2&#37;&#41; pacientes precisaron alguna hospitalizaci&#243;n por IC&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> muestra las curvas de Kaplan-Meier para la probabilidad acumulada de supervivencia &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41;&#44; supervivencia libre de hospitalizaci&#243;n por IC &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41; y muerte por causa cardiovascular o trasplante cardiaco &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>C&#41; en los pacientes con EPOC&#44; asma bronquial o ausencia de broncopat&#237;a&#46; Para los tres desenlaces analizados&#44; la prueba de rangos logar&#237;tmicos mostr&#243; un resultado significativamente peor en el grupo de pacientes con EPOC en comparaci&#243;n con el grupo de pacientes sin broncopat&#237;a &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 para los tres desenlaces&#41;&#44; sin diferencias significativas entre el grupo de pacientes con asma bronquial y el grupo de pacientes sin broncopat&#237;a &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05 para los tres desenlaces&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">An&#225;lisis multivariante</span><p id="par0150" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> muestra un resumen de los HR estimados mediante el m&#233;todo de regresi&#243;n multivariante de Cox para cada uno de los tres desenlaces cl&#237;nicos adversos evaluados en el estudio&#44; en pacientes con EPOC o asma&#44; en comparaci&#243;n con el grupo de referencia de pacientes sin broncopat&#237;a&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">La presencia de EPOC se asoci&#243; de forma independiente con un incremento significativo del riesgo de muerte por cualquier causa &#40;HR ajustado<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;64&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;33-2&#44;02&#41;&#44; muerte por cualquier causa u hospitalizaci&#243;n por IC &#40;HR ajustado<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;47&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;22-1&#44;76&#41; y muerte cardiovascular o trasplante cardiaco &#40;HR ajustado<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;39&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;08-1&#44;79&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">La presencia de asma bronquial no mostr&#243; un impacto significativo sobre el riesgo de ninguno de los tres eventos adversos analizados &#40;HR para muerte por cualquier causa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;98&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;63-1&#44;53&#59; HR para muerte u hospitalizaci&#243;n por IC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;72-1&#44;39&#59; HR para muerte cardiovascular o trasplante cardiaco<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;36&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;88-2&#44;11&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Causas de muerte</span><p id="par0165" class="elsevierStylePara elsevierViewall">Durante el seguimiento fallecieron 127 &#40;50&#44;6&#37;&#41; pacientes con EPOC&#44; 22 &#40;22&#44;9&#37;&#41; pacientes con asma bronquial y 628 &#40;28&#44;2&#37;&#41; pacientes sin broncopat&#237;a&#46; En todos los casos fue posible identificar una causa de muerte&#44; salvo en 1 &#40;0&#44;8&#37;&#41; muerte de pacientes con EPOC y en 13 &#40;2&#44;1&#37;&#41; muertes de pacientes sin broncopat&#237;a&#46; La relaci&#243;n de causas de muerte en cada grupo se representa en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">Las causas de muerte cardiovasculares&#44; en especial la IC y la muerte s&#250;bita&#44; fueron las m&#225;s frecuentes en los tres grupos&#44; ya que justificaron 75 &#40;59&#44;1&#37;&#41; de las muertes en pacientes con EPOC&#44; 15 &#40;68&#44;1&#37;&#41; de las muertes en pacientes con asma bronquial y 394 &#40;62&#44;7&#37;&#41; de las muertes en pacientes sin broncopat&#237;a&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discusi&#243;n</span><p id="par0175" class="elsevierStylePara elsevierViewall">En este trabajo hemos analizado la prevalencia y la repercusi&#243;n pron&#243;stica de la EPOC y el asma bronquial en una cohorte prospectiva de pacientes con IC remitidos a una unidad cl&#237;nica especializada de Cardiolog&#237;a entre enero de 2010 y junio de 2022&#46; Nuestros resultados indican que ambas patolog&#237;as son relativamente frecuentes en estos individuos y que su presencia se asocia a algunas diferencias en su perfil cl&#237;nico&#44; manejo terap&#233;utico y pron&#243;stico&#46; La presencia de EPOC se asoci&#243; de forma independiente con una menor supervivencia&#44; mientras que la presencia de asma bronquial no mostr&#243; un impacto pron&#243;stico significativo&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">En poblaciones no seleccionadas de pacientes con IC la prevalencia de EPOC ronda el 20&#37;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;2</span></a>&#44; mientras que la prevalencia de asma bronquial puede superar el 5&#37;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Sin embargo&#44; en nuestro estudio&#44; basado en una cohorte de pacientes con IC remitidos a una unidad especializada de Cardiolog&#237;a&#44; hemos observado una prevalencia de EPOC del 9&#44;7&#37; y una prevalencia de asma bronquial del 3&#44;7&#37;&#46; Esta aparente discordancia en los datos de prevalencia de patolog&#237;a broncopulmonar&#44; especialmente notoria en el caso de la EPOC&#44; puede explicarse por varias razones&#46; En primer lugar&#44; la asignaci&#243;n de los diagn&#243;sticos de EPOC o asma bronquial en nuestro estudio se hizo en base a su presencia en la historia cl&#237;nica del paciente&#44; sin una estrategia de b&#250;squeda activa de dichas patolog&#237;as&#46; Es posible&#44; por tanto&#44; que una parte de los casos m&#225;s leves hayan pasado inadvertidos&#46; En segundo lugar&#44; nuestro estudio presenta un sesgo de selecci&#243;n derivado del tipo de pacientes que se remiten de modo preferente a los programas de IC de Cardiolog&#237;a&#44; en general m&#225;s j&#243;venes y con menor agregaci&#243;n de comorbilidades que los pacientes con IC atendidos en otros servicios&#44; como Medicina Interna<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">9</span></a>&#46; La sobrerrepresentaci&#243;n del fenotipo de IC y FEVI reducida en nuestra cohorte&#44; tambi&#233;n entre los pacientes con patolog&#237;a broncopulmonar&#44; es otra prueba de ello&#46; Otros autores han observado una elevada prevalencia del fenotipo de IC con FEVI preservada entre los pacientes con asma bronquial<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a> o EPOC<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">En nuestra cohorte&#44; los pacientes con IC y EPOC o asma bronquial presentaban algunas caracter&#237;sticas cl&#237;nicas diferenciales en comparaci&#243;n con los pacientes sin broncopat&#237;a&#46; Al igual que en otras series<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;2</span></a>&#44; los pacientes con EPOC eran m&#225;s frecuentemente varones&#44; presentaban una edad media m&#225;s avanzada y&#44; consecuentemente&#44; mayor tiempo de evoluci&#243;n de la IC en el momento de su primera visita en la consulta especializada&#44; as&#237; como una mayor prevalencia de fibrilaci&#243;n o flutter auricular y una mayor prevalencia de enfermedad arterial coronaria y perif&#233;rica&#44; relacionada con su edad y con su elevada prevalencia de tabaquismo&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Tanto la presencia de EPOC como de asma bronquial se asociaron con clases funcionales de la NYHA m&#225;s avanzadas y con mayor prevalencia de signos f&#237;sicos de congesti&#243;n&#46; Los pacientes con EPOC presentaban otros datos adicionales de gravedad&#44; como una peor funci&#243;n renal&#44; mayores niveles plasm&#225;ticos de &#225;cido &#250;rico&#44; mayor frecuencia cardiaca en reposo&#44; mayor prevalencia de trastornos de conducci&#243;n intraventricular y complejos QRS m&#225;s prolongados&#46; Esta mayor severidad del cuadro cl&#237;nico de IC es concordante con estudios previos&#59; as&#237;&#44; se ha observado que los pacientes con IC y EPOC presentan peores par&#225;metros de rendimiento en la prueba de esfuerzo cardiopulmonar&#44; as&#237; como un remodelo ventricular adverso m&#225;s marcado que los pacientes con IC sin EPOC<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">La infrautilizaci&#243;n de betabloqueantes a los pacientes con IC y EPOC o asma bronquial es una constante en los estudios previos<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;2&#44;5&#44;6</span></a>&#44; y nuestro trabajo no constituye una excepci&#243;n&#46; En nuestra cohorte&#44; la frecuencia de prescripci&#243;n de betabloqueantes en los pacientes con EPOC o asma fue m&#225;s alta que la comunicada por otros autores<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;2&#44;5&#44;6</span></a>&#44; pero&#44; aun as&#237;&#44; fue inferior a la observada en pacientes con IC sin patolog&#237;a broncopulmonar&#46; En estos pacientes&#44; la cautela relativa al empleo de betabloqueantes viene dada por la posibilidad de agravamiento de la patolog&#237;a broncopulmonar&#46; Sin embargo&#44; la evidencia disponible indica que en pacientes con broncopat&#237;a y una indicaci&#243;n cardiovascular consolidada para recibir betabloqueantes los beneficios del tratamiento superan a sus riesgos&#44; ya que este se asocia a una mayor supervivencia<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> e incluso a una menor incidencia de descompensaciones respiratorias<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a>&#46; Por este motivo&#44; la presencia de EPOC o de asma bronquial no se considera actualmente una contraindicaci&#243;n para el inicio de betabloqueantes&#44; preferentemente cardioselectivos&#44; con una observaci&#243;n cl&#237;nica estrecha para anticipar la aparici&#243;n de efectos adversos<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Otro resultado llamativo de nuestro estudio es la mayor prescripci&#243;n relativa de inhibidores del cotransportador de sodio-glucosa tipo<span class="elsevierStyleHsp" style=""></span>2 en pacientes con asma bronquial&#44; que ponemos en relaci&#243;n con la mayor proporci&#243;n relativa de pacientes con asma bronquial que fueron remitidos a la unidad de IC en la era m&#225;s reciente y que&#44; por tanto&#44; tuvieron la oportunidad de recibir este grupo farmacol&#243;gico una vez que su indicaci&#243;n terap&#233;utica se hubo consolidado<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">En nuestro estudio hemos observado una menor frecuencia de implantaci&#243;n de desfibriladores implantables en los pacientes con IC y EPOC o asma en comparaci&#243;n con los pacientes sin patolog&#237;a broncopulmonar&#46; La evidencia disponible avala la eficacia de esta terapia en pacientes con EPOC<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">15</span></a>&#44; pero estos individuos presentan un riesgo incrementado de complicaciones infecciosas<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a> y neumot&#243;rax<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a>&#59; adem&#225;s&#44; la presencia de EPOC se asocia de forma independiente con una menor supervivencia en portadores de desfibrilador<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a>&#46; La aparente infrautilizaci&#243;n de desfibriladores profil&#225;cticos en pacientes con IC y EPOC en nuestro estudio podr&#237;a estar en relaci&#243;n con el diferente perfil cl&#237;nico de este subgrupo&#44; al tratarse de pacientes de mayor edad&#44; con mayor agregaci&#243;n de comorbilidades y una situaci&#243;n de IC m&#225;s avanzada&#44; que resultar&#237;a en una relaci&#243;n riesgo&#47;beneficio menos favorable para la terapia<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">19</span></a>&#46; Menos evidentes resultan las razones que pueden justificar la relativa baja tasa de implante de desfibriladores profil&#225;cticos en pacientes con IC y asma bronquial&#44; resultado que podr&#237;a estar en relaci&#243;n con la menor prevalencia relativa en este subgrupo de pacientes del fenotipo de IC con FEVI reducida&#44; el &#250;nico en el que existe una indicaci&#243;n clara para dicha terapia<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; los pacientes con IC y EPOC presentaron una menor supervivencia global&#44; una menor supervivencia libre de hospitalizaci&#243;n por IC y una mayor incidencia del desenlace combinado muerte cardiovascular o trasplante cardiaco que los pacientes sin patolog&#237;a broncopulmonar&#46; La asociaci&#243;n entre la presencia de EPOC y pron&#243;stico adverso se mantuvo en los modelos multivariantes dise&#241;ados para controlar posibles sesgos de confusi&#243;n derivados de diferencias en el perfil cl&#237;nico y en el tratamiento de estos pacientes&#44; lo que apoya que la EPOC es un verdadero factor pron&#243;stico independiente en esta poblaci&#243;n&#46; Otros autores han identificado asociaciones similares entre la presencia de EPOC y un incremento del riesgo de muerte por cualquier causa<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;2&#44;5&#44;20</span></a>&#44; muerte por causas cardiovasculares<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;20</span></a> y hospitalizaciones por IC<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Cabe destacar que&#44; al igual que en los pacientes sin patolog&#237;a broncopulmonar&#44; en los pacientes con IC y EPOC de nuestra cohorte predominaron las causas cardiovasculares de muerte&#44; en especial la IC refractaria y la muerte s&#250;bita&#44; mientras que las causas no cardiovasculares&#44; como infecciones y neoplasias&#44; fueron minoritarias&#46; En conjunto&#44; nuestros resultados sugieren que&#44; en pacientes con IC&#44; la coexistencia de EPOC no solo dificulta la optimizaci&#243;n terap&#233;utica&#44; sino que puede contribuir a que la propia IC evolucione de forma desfavorable&#46; Existe&#44; adem&#225;s&#44; una base fisiopatol&#243;gica que sustenta esta hip&#243;tesis<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a>&#44; ya que se conoce que la disfunci&#243;n ventilatoria&#44; las alteraciones del intercambio gaseoso y la hiperinsuflaci&#243;n pulmonar propias de la EPOC inducen cambios patol&#243;gicos en la morfolog&#237;a y el tama&#241;o de las c&#225;maras cardiacas&#44; hipertrofia y remodelado exc&#233;ntrico ventricular&#44; favoreciendo la aparici&#243;n de alteraciones hemodin&#225;micas&#44; como reducci&#243;n del volumen de eyecci&#243;n y del gasto cardiaco&#44; incremento de la rigidez arterial sist&#233;mica y pulmonar y&#44; en estadios avanzados&#44; fracaso ventricular derecho&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Nuestro estudio no ha demostrado una asociaci&#243;n significativa entre la presencia de asma bronquial y el pron&#243;stico de los pacientes con IC&#46; Tanto en los an&#225;lisis no ajustados como en los an&#225;lisis ajustados&#44; los pacientes con IC y asma bronquial presentaron una supervivencia global&#44; una supervivencia libre de ingreso por IC y una incidencia del desenlace combinado muerte cardiovascular o trasplante cardiaco comparables a las de los pacientes sin patolog&#237;a broncopulmonar&#46; En un peque&#241;o estudio japon&#233;s basado en una cohorte de 191 pacientes con IC y ausencia de EPOC&#44; con un perfil cl&#237;nico diferente al de nuestra cohorte&#44; con una alta prevalencia de IC con FEVI preservada y una baja tasa de prescripci&#243;n de betabloqueantes&#44; la presencia de asma bronquial s&#237; se asoci&#243; a un incremento de la mortalidad por todas las causas<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a>&#46; Sin embargo&#44; en una gran cohorte de m&#225;s de 200&#46;000 pacientes hospitalizados por IC en Inglaterra y Gales &#250;nicamente la presencia de EPOC&#44; pero no la presencia de asma&#44; se asoci&#243; con un incremento de la mortalidad intrahospitalaria<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a>&#46; M&#225;s all&#225; de sus potenciales implicaciones sobre la optimizaci&#243;n terap&#233;utica&#44; es posible que la ausencia de una clara repercusi&#243;n del asma bronquial en el pron&#243;stico de los pacientes con IC se deba a su car&#225;cter epis&#243;dico y a su limitado impacto sobre la funci&#243;n cardiovascular<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a>&#46;</p><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Limitaciones</span><p id="par0220" class="elsevierStylePara elsevierViewall">El presente estudio tiene algunas limitaciones&#44; derivadas de su car&#225;cter observacional&#46; El escenario cl&#237;nico en el que se ha realizado el estudio&#44; una unidad de IC&#44; condiciona un probable sesgo de selecci&#243;n derivado del perfil de pacientes que se derivan a estos programas&#44; habitualmente m&#225;s j&#243;venes&#44; con mayor prevalencia de cardiopat&#237;a isqu&#233;mica y FEVI reducida y con menor agregaci&#243;n de comorbilidad que los pacientes de la poblaci&#243;n general con IC&#46; Por este motivo&#44; la validez externa de nuestras observaciones no est&#225; garantizada&#46; Adem&#225;s&#44; los diagn&#243;sticos de EPOC y de asma bronquial se realizaron exclusivamente en base a su constancia en la historia cl&#237;nica del paciente&#44; sin replantearlos <span class="elsevierStyleItalic">a posteriori</span> ni realizar una b&#250;squeda activa de los mismos&#46; La fuente de datos utilizada es un registro de pr&#225;ctica cl&#237;nica habitual&#44; no dise&#241;ado de forma dirigida para este estudio&#44; lo que ha condicionado la falta de alguna informaci&#243;n que podr&#237;a resultar de inter&#233;s&#44; como la relativa al tratamiento farmacol&#243;gico de la patolog&#237;a broncopulmonar o a los par&#225;metros de funci&#243;n respiratoria&#46; Por &#250;ltimo&#44; debe reconocerse la posibilidad de sesgos de confusi&#243;n que podr&#237;an persistir pese a los ajustes multivariantes realizados&#44; especialmente en relaci&#243;n con caracter&#237;sticas cl&#237;nicas no medidas&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conclusiones</span><p id="par0225" class="elsevierStylePara elsevierViewall">Nuestro estudio&#44; basado en una cohorte de 2&#46;577 pacientes con IC atendidos en una unidad cl&#237;nica especializada de Cardiolog&#237;a entre enero de 2010 y junio de 2022&#44; constata que la coexistencia de patolog&#237;a broncopulmonar &#40;asma bronquial o EPOC&#41; se asocia a diferencias en el perfil cl&#237;nico&#44; el tratamiento y el pron&#243;stico de estos individuos&#46; En nuestra cohorte&#44; los pacientes con IC y asma bronquial o EPOC recibieron con menos frecuencia tratamiento betabloqueante y desfibriladores profil&#225;cticos que los pacientes sin patolog&#237;a broncopulmonar&#46; La presencia de EPOC&#44; pero no as&#237; la de asma bronquial&#44; se identific&#243; como un predictor independiente de pron&#243;stico adverso&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">En el futuro ser&#225;n necesarios nuevos estudios que permitan profundizar en el conocimiento de los mecanismos fisiopatol&#243;gicos subyacentes en pacientes con IC y patolog&#237;a broncopulmonar para individualizar su manejo cl&#237;nico&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Financiaci&#243;n</span><p id="par0235" class="elsevierStylePara elsevierViewall">Algunos de los autores del manuscrito son miembros del grupo CB16&#47;11&#47;00425 del Centro de Investigaci&#243;n Biom&#233;dica en Red de Enfermedades Cardiovasculares &#40;CIBERCV&#41; del Instituto de Salud Carlos<span class="elsevierStyleHsp" style=""></span>III&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">El estudio no ha contado con otro tipo de financiaci&#243;n espec&#237;fica diferente a la que nuestro grupo recibe anualmente por su participaci&#243;n en dicha red tem&#225;tica&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflicto de intereses</span><p id="par0250" class="elsevierStylePara elsevierViewall">Los autores no declaran conflicto de intereses en relaci&#243;n con esta publicaci&#243;n&#46;</p></span></span>"
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    "fechaRecibido" => "2024-01-03"
    "fechaAceptado" => "2024-01-15"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1792388"
          "palabras" => array:5 [
            0 => "Insuficiencia cardiaca"
            1 => "Pron&#243;stico"
            2 => "Tratamiento"
            3 => "EPOC"
            4 => "Asma"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1792387"
          "palabras" => array:5 [
            0 => "Heart failure"
            1 => "Prognosis"
            2 => "Treatment"
            3 => "COPD"
            4 => "Bronchial asthma"
          ]
        ]
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    "tieneResumen" => true
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Prop&#243;sito</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar el impacto de la enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41; y el asma bronquial sobre el manejo terap&#233;utico y el pron&#243;stico de los pacientes con insuficiencia cardiaca &#40;IC&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis de la informaci&#243;n contenida en un registro cl&#237;nico de pacientes remitidos a una unidad especializada de IC entre enero de 2010 y junio de 2022&#46; Se compararon su perfil cl&#237;nico&#44; el tratamiento y el pron&#243;stico en base a la presencia de EPOC o asma bronquial&#46; El an&#225;lisis de supervivencia se realiz&#243; mediante los m&#233;todos de Kaplan-Meier y Cox&#46; La mediana de seguimiento fue de 1&#46;493 d&#237;as&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron 2&#46;577 pacientes&#44; de los cuales 251 &#40;9&#44;7&#37;&#41; presentaban EPOC y 96 &#40;3&#44;7&#37;&#41;&#44; asma bronquial&#46; Observamos diferencias significativas entre los tres grupos con respecto a la prescripci&#243;n de betabloqueantes &#40;EPOC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>89&#44;6&#37;&#59; asma<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>87&#44;5&#37;&#59; no broncopat&#237;a<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>94&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; e inhibidores del cotransportador de sodio-glucosa tipo<span class="elsevierStyleHsp" style=""></span>2 &#40;EPOC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35&#44;1&#37;&#59; asma<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#37;&#59; no broncopat&#237;a<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;036&#41;&#46; Adem&#225;s&#44; los pacientes con patolog&#237;a bronquial recibieron con menor frecuencia un desfibrilador &#40;EPOC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#44;3&#37;&#59; asma<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#44;8&#37;&#59; no broncopat&#237;a<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La presencia de EPOC se asoci&#243; de forma independiente con mayor riesgo de muerte por cualquier causa &#40;HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;64&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;33-2&#44;02&#41;&#44; muerte u hospitalizaci&#243;n por IC &#40;HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;47&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;22-1&#44;76&#41; y muerte cardiovascular o trasplante cardiaco &#40;HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;39&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;08-1&#44;79&#41; en comparaci&#243;n con la ausencia de broncopat&#237;a&#46; La presencia de asma bronquial no se asoci&#243; a un impacto significativo sobre los desenlaces analizados&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La EPOC&#44; pero no el asma bronquial&#44; es un factor pron&#243;stico adverso e independiente en pacientes con IC&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Prop&#243;sito"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Purpose</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To analyze the impact of chronic obstructive pulmonary disease &#40;COPD&#41; and bronchial asthma on therapeutic management and prognosis of patients with heart failure &#40;HF&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Analysis of the information collected in a clinical registry of patients referred to a specialized HF unit from January-2010 to June-2012&#46; Clinical profile&#44; treatment and prognosis of patients was evaluated&#44; according to the presence of COPD or asthma&#46; Survival analyses were conducted by means of Kaplan-Meier and Cox&#39;s methods&#46; Median follow-up was 1493 days&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We studied 2577 patients&#44; of which 251 &#40;9&#46;7&#37;&#41; presented COPD and 96 &#40;3&#46;7&#37;&#41; bronchial asthma&#46; Significant differences among study groups were observed regarding to the prescription of beta-blockers &#40;COPD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>89&#46;6&#37;&#59; asthma<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>87&#46;5&#37;&#59; no bronchopathy<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>94&#46;1&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41; and SGLT2 inhibitors &#40;COPD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35&#46;1&#37;&#59; asthma<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#37;&#59; no bronchopathy<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#46;3&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;036&#41;&#46; Also&#44; patients with bronchial disease received less frequently a defibrillator &#40;COPD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#46;3&#37;&#59; asthma<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#46;8&#37;&#59; no broncopathy<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41;&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">COPD was independently associated with increased risk of all-cause mortality &#40;HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;64&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;33-2&#46;02&#41;&#44; all-cause death or HF admission &#40;HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;47&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;22-1&#46;76&#41; and cardiovascular death or heart transplantation &#40;HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;39&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;08-1&#46;79&#41; as compared with patients with no bronchopathy&#46; Bronchial asthma was not significantly associated with increased risk of adverse outcomes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">COPD&#44; but not asthma&#44; is an adverse independent prognostic factor in patients with HF&#46;</p></span>"
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            "titulo" => "Purpose"
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            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
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            "identificador" => "abst0040"
            "titulo" => "Conclusions"
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Curvas de Kaplan-Meier para supervivencia global &#40;A&#41;&#44; supervivencia libre de ingreso por insuficiencia cardiaca &#40;B&#41; y probabilidad acumulada de muerte cardiovascular o trasplante cardiaco &#40;C&#41; en los tres grupos a estudio&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">EPOC&#58; enfermedad pulmonar obstructiva cr&#243;nica&#46;</p>"
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n de las causas de muerte durante el seguimiento a largo plazo en los tres grupos a estudio&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">EPOC&#58; enfermedad pulmonar obstructiva cr&#243;nica&#46;</p>"
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        "detalles" => array:1 [
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            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">DDVI&#58; di&#225;metro diast&#243;lico del ventr&#237;culo izquierdo&#59; DSVI&#58; di&#225;metro sist&#243;lico del ventr&#237;culo izquierdo&#59; EPOC&#58; enfermedad pulmonar obstructiva cr&#243;nica&#59; FEVI&#58; fracci&#243;n de eyecci&#243;n del ventr&#237;culo izquierdo&#59; GGT&#58; gamma-glutamil transpeptidasa&#59; GOT&#58; glutamato-oxalato transaminasa&#59; GPT&#58; glutamato-piruvato transaminasa&#59; IC&#58; insuficiencia cardiaca&#59; NT-proBNP&#58; fracci&#243;n N-terminal del prop&#233;ptido natriur&#233;tico cerebral&#59; NYHA&#58; <span class="elsevierStyleItalic">New York Heart Association</span>&#59; PSAP&#58; presi&#243;n sist&#243;lica de arteria pulmonar&#59; TAPSE&#58; distancia de excursi&#243;n sist&#243;lica del anillo tricusp&#237;deo&#59; UI&#58; unidades internacionales&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sin broncopat&#237;a&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2230&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Historia cl&#237;nica previa</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sexo femenino</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">618 &#40;27&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36 &#40;14&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44 &#40;45&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#205;ndice de masa corporal &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;428&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Tiempo desde el diagn&#243;stico de IC</span><span class="elsevierStyleItalic">&#40;d&#237;as&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">952&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;970&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;031&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hospitalizaci&#243;n previa por IC</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">877 &#40;39&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">134 &#40;53&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28 &#40;29&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Consumo de alcohol &#40;&#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">40</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">g&#47;d&#237;a&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">568 &#40;25&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">91 &#40;36&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;18&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;270 &#40;57&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">43 &#40;44&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hipertensi&#243;n arterial</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;187 &#40;53&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">148 &#40;59&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53 &#40;55&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;217&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dislipemia</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;295 &#40;58&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">152 &#40;60&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">62 &#40;64&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;356&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Diabetes mellitus</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">691 &#40;31&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">86 &#40;34&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26 &#40;27&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;386&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cardiopat&#237;a isqu&#233;mica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;050 &#40;47&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">114 &#40;45&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">31 &#40;32&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Infarto de miocardio previo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">719 &#40;32&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">74 &#40;29&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19 &#40;19&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ictus previo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">206 &#40;9&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31 &#40;12&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;7&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;212&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enfermedad arterial perif&#233;rica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">152 &#40;6&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36 &#40;14&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;5&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Neoplasia previa</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">347 &#40;15&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">48 &#40;19&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">19 &#40;19&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;207&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Situaci&#243;n cl&#237;nica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Clase funcional NYHA</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Clase I&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">270 &#40;12&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;3&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;11&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Clase II&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;255 &#40;56&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">142 &#40;56&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44 &#40;45&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Clase III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">640 &#40;28&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">88 &#40;35&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">39 &#40;40&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Clase IV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;2&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">12 &#40;4&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2 &#40;2&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Signos de congesti&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">422 &#40;18&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">61 &#40;24&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">28 &#40;29&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Congesti&#243;n pulmonar</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">249 &#40;11&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">42 &#40;16&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">15 &#40;15&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Congesti&#243;n sist&#233;mica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">330 &#40;14&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">50 &#40;19&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">26 &#40;27&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Frecuencia card&#237;aca &#40;latidos&#47;min&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#44;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">73&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Presi&#243;n arterial sist&#243;lica &#40;mmHg&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">116&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;525&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Presi&#243;n arterial diast&#243;lica &#40;mmHg&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Electrocardiograma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ritmo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;035&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sinusal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;509 &#40;67&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">149 &#40;59&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;72&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Fibrilaci&#243;n o flutter auricular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">611 &#40;27&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79 &#40;31&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;21&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Otro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98 &#40;4&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;8&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;4&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Desconocido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;0&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Trastorno de conducci&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Bloqueo de rama izquierda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">466 &#40;20&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#40;18&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;14&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Bloqueo de rama derecha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">163 &#40;7&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;13&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;3&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Otro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;2&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;2&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;3&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;543 &#40;69&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">163 &#40;64&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Duraci&#243;n del complejo QRS &#40;ms&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ivabradina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32 &#40;12&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;11&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;357&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Desfibrilador autom&#225;tico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">349 &#40;15&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;9&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;9&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Terapia de resincronizaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">71 &#40;3&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;2&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;498&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Seguimiento en la unidad de IC</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Betabloqueante&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;098 &#40;94&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">225 &#40;89&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">84 &#40;87&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antagonista del receptor mineralcorticoide&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;860 &#40;83&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">204 &#40;81&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">83 &#40;86&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;485&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inhibidor del cotransportador de sodio-glucosa tipo<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">854 &#40;38&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">88 &#40;35&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">48 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;036&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inhibidor de la enzima conversora de la angiotensina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;137 &#40;51&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">127 &#40;50&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41 &#40;42&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;283&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antagonista del receptor de angiotensina<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">465 &#40;20&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">54 &#40;21&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;21&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;946&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sacubitril-valsart&#225;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;027 &#40;46&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">106 &#40;42&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">45 &#40;46&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;501&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diur&#233;tico de asa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;891 &#40;84&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">224 &#40;89&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">79 &#40;82&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tiazida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">367 &#40;16&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">48 &#40;19&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">17 &#40;17&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;545&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Digoxina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">289 &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">39 &#40;15&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;16&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;325&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ivabradina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">476 &#40;21&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;24&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;352&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Desfibrilador autom&#225;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">647 &#40;29&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;20&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20 &#40;20&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Terapia de resincronizaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">199 &#40;8&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;6&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;204&nbsp;\t\t\t\t\t\t\n
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            0 => array:3 [
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Tratamiento farmacol&#243;gico e implante de dispositivos endocavitarios en los pacientes del estudio&#44; clasificados en tres grupos en base a la presencia de EPOC&#44; asma o ausencia de broncopat&#237;a&#44; tanto en el momento de la primera visita en la unidad de insuficiencia cardiaca como durante el seguimiento en la misma</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Desenlace cl&#237;nico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EPOC vs&#46; ausencia de broncopat&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;64 &#40;1&#44;33-2&#44;02&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asma bronquial vs&#46; ausencia de broncopat&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Muerte u hospitalizaci&#243;n por IC</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EPOC vs&#46; ausencia de broncopat&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;75 &#40;1&#44;48-2&#44;07&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;47 &#40;1&#44;22-1&#44;76&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asma bronquial vs&#46; ausencia de broncopat&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;72-1&#44;39&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asma bronquial vs&#46; ausencia de broncopat&#237;a&nbsp;\t\t\t\t\t\t\n
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        0 => array:2 [
          "identificador" => "bibs0015"
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            0 => array:3 [
              "identificador" => "bib0115"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and prognostic impact of chronic obstructive pulmonary disease in patients with chronic heart failure&#58; Data from the GISSI-HF trial"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Canepa"
                            1 => "P&#46;L&#46; Temporelli"
                            2 => "A&#46; Rossi"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000448166"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cardiology&#46;"
                        "fecha" => "2017"
                        "volumen" => "136"
                        "paginaInicial" => "128"
                        "paginaFinal" => "137"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27618363"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characteristics&#44; treatments and 1-year prognosis of hospitalized and ambulatory heart failure patients with chronic obstructive pulmonary disease in the European Society of Cardiology Heart Failure Long-Term Registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Canepa"
                            1 => "E&#46; Straburzynska-Migaj"
                            2 => "J&#46; Drozdz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ejhf.964"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Heart Fail&#46;"
                        "fecha" => "2018"
                        "volumen" => "20"
                        "paginaInicial" => "100"
                        "paginaFinal" => "110"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28949063"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            2 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic and therapeutic challenges in patients with coexistent chronic obstructive pulmonary disease and chronic heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;H&#46; Le Jemtel"
                            1 => "M&#46; Padeletti"
                            2 => "S&#46; Jelic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2006.08.046"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2007"
                        "volumen" => "49"
                        "paginaInicial" => "171"
                        "paginaFinal" => "180"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17222727"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic and therapeutic gaps in patients with heart failure and chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Canepa"
                            1 => "F&#46;M&#46;E&#46; Franssen"
                            2 => "H&#46; Olschewski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jchf.2019.05.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "JACC Heart Fail&#46;"
                        "fecha" => "2019"
                        "volumen" => "7"
                        "paginaInicial" => "823"
                        "paginaFinal" => "833"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31521680"
                            "web" => "Medline"
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Información del artículo
ISSN: 00142565
Idioma original: Español
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Revista Clínica Española
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?