European journal of internal medicine
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Renin-angiotensin-aldosterone system inhibitors (RAASi) and mineralocorticoid receptor antagonists (MRAs) are key drugs in the management of patients with cardiovascular diseases (CVD), particularly those with hypertension, diabetes, chronic kidney disease and heart failure (HF), given their demonstrated effectiveness in reducing the risk of both surrogate and hard endpoints. Despite their positive impact on the outcome, patients with RAASi and MRAs are particularly vulnerable to hyperkalaemia, with approximately 50 % of these individuals experiencing two or more recurrences annually. ⋯ Recent guidelines from cardiovascular and renal international societies increasingly recognize the need for alternative strategies to manage the risk of hyperkalaemia, allowing the continuation of RAASi and MRA therapies. In this review, we summarise the new potential options available to manage hyperkalaemia in patients with CVD and the recommendations of the most recent guidelines on the topic.
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Eur. J. Intern. Med. · Feb 2025
Multicenter StudyDifferent impact of chronic kidney disease in older patients with heart failure according to frailty.
Chronic kidney disease (CKD) and frailty are often present in older patients with heart failure (HF). Our aim was to evaluate the association of CKD and frailty in one-year mortality in a cohort of older (≥75 years) outpatients with HF METHODS: Our data come from the FRAGIC study ("impacto de la FRAGilidad y otros síndromes Geriátricos en el manejo clínico y pronóstico del paciente anciano ambulatorio con Insuficiencia Cardíaca"), a multicenter prospective registry conducted in 16 cardiology services in Spain which included ≥75 years outpatients with HF. Renal function was assessed according to CKD-EPI formula. A comprehensive geriatric assessment was performed and frailty was identified according to visual mobility scale (frail if VMS≥2). Survival rates were analyzed by Cox regression model. ⋯ Most HF patients≥75 years have renal dysfunction. CKD is a marker of worse prognosis in elderly patients with chronic HF, but it does not independently associate one-year mortality in the presence of frailty.
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Eur. J. Intern. Med. · Feb 2025
Observational StudyLong-term follow-up of hereditary hemorrhagic telangiectasia patients without significant pulmonary right-to-left shunt at screening.
To describe the incidence of pulmonary arteriovenous malformations (PAVM)-related complications, right-to-left shunt (RLS) progression at transthoracic contrast echocardiography (TTCE) and development of treatable PAVM during long-term follow-up in hereditary hemorrhagic telangiectasia (HHT) patients with RLS grades 0-1 at screening TTCE. ⋯ In HHT patients with grades 0-1 RLS at screening, PAVM-related complications are rare. No patient with grade 0 RLS showed an increase in RLS of more than one grade on TTCE. Among patients with grade 1 RLS, rescreening every 5 years should be recommended because treatable PAVM can develop; follow-up with TTCE could be an alternative, as it would allow a better selection of patients for chest CT.
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Eur. J. Intern. Med. · Feb 2025
Practice GuidelineTreatment of hospitalized patient with hyperglycemia: An EFIM critically appraised and adapted guideline.
Over the past decade, diabetes mellitus (DM) has emerged as a growing epidemic, with a direct link to an increased risk of hospitalization and a strong effect of glycemic control on clinical outcomes. The aim of this document was to critically appraise and adapt existing clinical practice guidelines (CPGs) to provide specific recommendations for the management of hyperglycemia in hospitalized adults with and without previously known DM, in an attempt to provide a practical tool to reduce the risk of major in-hospital complications. ⋯ Using a systematic methodology, this guideline provides an updated and ease-to-use tool for the management of hospitalized adults with hyperglycemia.