Heart failure, 1st cause of admission in people over 65

Opening table of the XXIV Meeting of the Heart Failure and Atrial Fibrillation Group of the Spanish Society of Internal Medicine (SEMI).

More than 480 internists met last Thursday and Friday, April 21 and 22, in Madrid, at the XXIV Meeting of the Heart Failure and Atrial Fibrillation Group of the Spanish Society of Internal Medicine (SEMI), where they analyzed the main diagnostic and therapeutics in these pathologies. Under a multi and interdisciplinary approach and with the participation of Nursing professionals, the main novelties in the pharmacological field of heart failure (both with reduced and preserved ejection fraction), among other topics of scientific relevance, have been addressed, tools to identify and manage refractory congestion, techniques to deal with complex scenarios in anticoagulation of patients with atrial fibrillation and update contents on cardiac amyloidosis.

In the words of Jesús Casado Cerrada, coordinator of the SEMI Heart Failure and Atrial Fibrillation Group (ICyFA), “currently heart failure is the first cause of hospitalization in patients older than 65 years. On a global level, we can say that there are more than 750,000 people over 18 years of age with heart failure in Spain, that this prevalence increases slightly every year and that, in those over 80 years of age, it can exceed 9 percent.”

Patients with heart failure and/or atrial fibrillation have “a high degree of comorbidities”, according to Casado, “both cardiovascular and non-cardiovascular pathologies, although renal failure, arterial hypertension (HTN), diabetes and obesity are highly prevalent among our patients.

The internist, as recalled at the meeting, is “highly trained in the global and systemic approach to comorbidities, especially in complex scenarios with a high degree of uncertainty”, so in this context, and being heart failure and atrial fibrillation, two pathologies with a high burden of comorbidity, specialists in Internal Medicine “play a fundamental role in its approach”.

So much so that heart failure is one of the most frequent causes of hospital admission in Internal Medicine. In Spain, in 2021, there were around 120,000 admissions for this pathology in the SNS as a whole, of which some 100,000 were treated in Internal Medicine, according to the data presented during the meeting.

Precisely, the SEMI led, in 2011, a program for the implementation of the so-called Comprehensive Management Units for Patients with Heart Failure (UMIPIC), in which the follow-up of patients with this pathology is carried out in a coordinated manner with other specialists such as Primary Care, with the aim of “homogenizing a common work scheme, with the presence of specialized Nursing and providing protocols that serve as practical guide for the control of the disease”. Among the results achieved in these units, as shown at the meeting, in the session on UMIPIC, are “the reduction in admissions and mortality andn heart failure with preserved ejection fraction”.

Inauguration of the XXIV Meeting of the Heart Failure and Atrial Fibrillation Group

The inauguration of the meeting has been in charge of the president of the SEMI, Jesús Díez Manglano; the president of the Internal Medicine Society of Madrid-Castilla La Mancha (Somimaca), Manuel Méndez Bailón; the president of the Organizing Committee of the XXIV ICyFA-SEMI Meeting and SEMI advisor, Luis Manzano; and the coordinator of the ICyFA-SEMI Group, Jesús Casado Cerrada. All have agreed to highlight “the success of the event and the high participation of internists concerned about learning and improving care for patients with these pathologies, as well as their high scientific quality”.

After the inauguration, the table “Acute Heart Failure” took place and, later, the inaugural conference, with the title “Organization of the care process for Heart Failure. Measure to improve”. In the first of the tables, they spoke of the “importance of tdiuretic treatment in congestion” and “start treatment disease modifier during admission. Mention was also made of the utility of clinical ultrasound for early detection of congestion in the context of heart failure”.

Clinical Records and Task Force Investigations

The ICyFA working group of the SEMI, with 1,597 active members currently, is dedicated to providing up-to-date, useful and practical information for all health professionals who have to care for patients with these pathologies. Recently, the group has created new accessible information channelsagile and pragmatic like AppICFA (with more than 1,500 downloads in the first month alone)an informative channel on pathologies on YouTube and the podcast show “To the beat of the present”. But in addition to training and information, the group also contributes to generating quality scientific evidence, with clinical trials, registries and multicenter observational studies. Precisely, the main novelties of the studies and investigations in progress were presented at the meeting.

Among the Group’s flagship registries, RICA (National Registry of Acute Heart Failure) stands out, whose phase 2 -RICA 2- is currently being developed. This registry makes it possible to analyze the clinical profile of patients with HF and generate hypotheses about the best way to manage these complex patients. Other registries and investigations of the group include: EPICC, PREVAMIC and REGAMIC, ALCALOTIC, CLOROTIC or PROFUND-IC.

Meeting program and topics covered

During the morning of Thursday, different practical workshops (clinical ultrasound of congestion in heart failure and advanced echocardioscopy in heart failure), and the clinical case competition, as well as the UMIPIC meeting. Other workshops were held in the afternoon (approach to refractory congestion, diabetes and heart failure, debut atrial fibrillation and the usefulness of high-flow oxygen therapy and non-invasive mechanical ventilation in acute HF), in addition to a nursing round table The official inauguration also took place, as well as the table “Acute Heart Failure” and the inaugural conference “Organization of the heart failure care process. Measure to improve”.

For its part, on Friday, April 22, the key aspects of the practical workshops were reviewed, the working group’s own table was developed, in which the different clinical records and investigations of the Working Group were reported, and The nursing round table “New challenges in nursing care in heart failure” and the table on “Atrial Fibrillation” were held, as well as an activity on “Hard Topics in Heart Failure: brain and HF” and the session “Face to face : Rule out amyloidosis in all patients with Preserved Ejection Fraction”. In the afternoon, in the last part of the meeting, an interactive table was developed on “Heart Failure with Preserved Ejection Fraction” and another entitled “HF Table with Reduced Ejection Fraction”. Before the closing, a lecture was given on “The best in the last year of Heart Failure and Atrial Fibrillation”.

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