Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Nov 2021
Multicenter StudyBurden of multimorbidity in a Polish cohort of ambulatory and hospitalized heart failure patients from two large European registry programs: prognostic implications.
Introduction: Individual comorbidities have been shown to adversely affect prognosis in heart failure (HF). However, our knowledge of multimorbidity in HF and understanding of its prognostic implications still remain incomplete. Objectives: We aimed to analyze the prevalence of multimorbidity in Polish HF patients and to investigate the quantitative and qualitative impact of comorbidity burden on 12-month outcomes in that population. Patients and methods: We retrospectively analyzed data of 1765 Polish patients with ambulatory or acute (requiring hospitalization) HF from 2 multicenter observational European Society of Cardiology registries: the ESC-HF Pilot Survey (2009–2010) and ESC-HF-LT Registry (2011–2013). Results: Arterial hypertension and coronary artery disease were the most prevalent comorbidities, similarly to the entire European cohort. The great majority of HF patients had more than 1 predefined comorbidity and the most frequent number of comorbidities was 3. ⋯ The best accuracy for predicting the adjusted 12-month rate of all-cause death was ensured by the model including only anemia and kidney dysfunction. The model including 4 comorbidities—anemia, kidney dysfunction, diabetes, and coronary artery disease—provided best accuracy for predicting 12-month rate of composite all-cause death or HF hospitalization. Conclusions: Multimorbidity is highly prevalent in a real-world cohort of Polish HF patients and the quantitative burden of comorbidities is related to increased mortality. In such patients, the clinical profile characterized by pathophysiological continuum of diabetes, kidney dysfunction, and anemia is particularly associated with unfavorable outcomes.
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Pol. Arch. Med. Wewn. · Nov 2021
Randomized Controlled TrialOptimal medical therapy in patients with stable coronary artery disease in Poland. The ISCHEMIA Trial experience.
Introduction: Optimal medical therapy (OMT) is the cornerstone of treatment for stable coronary disease with the ISCHEMIA trial showing similar outcomes using OMT with or without an initial invasive approach. Objectives: To describe OMT goal attainment in Polish ISCHEMIA participants compared with other countries. Patients and methods: Among 5179 trial participants, 333 were randomized in Poland. The median follow-up was 3.2 years. ⋯ In Poland, significant improvements were achieved regarding high-intensity statin therapy (27% vs 50%), LDL-C <70 mg/dl (29% vs 65%), and systolic blood pressure of less than 140 mm Hg (63% vs 81%) (P <0.001 for all), whereas not-smoking (89% vs 89%), aspirin (90% vs 88%), ACEI / ARB (93% vs 95%), and β-blocker therapy (94% vs 90%) remained high. Conclusions: With regular surveillance and contemporary medical therapy, high OMT goal attainment was achievable among the participants of the ISCHEMIA trial in Poland relative to other countries. There is still room for improvement in LDL-C and blood pressure management.
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Pol. Arch. Med. Wewn. · Nov 2021
3-year mortality after acute myocardial infarction in patients with different diabetic status.
The prevalence of diabetes mellitus (DM) in patients with myocardial infarction (MI) is estimated at about 25%. Short- and long-term prognosis is worse in patients with DM and hyperglycemia compared with nondiabetics. ⋯ T1DM and T2DM are associated with elevated in-hospital and long-term mortality rates after MI. Diabetics and patients with transient hyperglycemia are more likely to develop significant in-hospital complications compared with nondiabetics. No significant differences regarding acute mechanical complications were noted between populations.
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Pol. Arch. Med. Wewn. · Nov 2021
Outcomes of COVID-19 in hospitalized kidney and liver transplant recipients- a single-center experience.
Introduction: Solid organ transplant recipients seem to be more susceptible to severe COVID-19. Objectives: Our study aimed to assess the clinical outcomes of COVID-19 in kidney (KTRs) and liver transplant recipients (LTRs). Patients and methods: In this single-center study, the medical records of KTRs and LTRs with PCR-confirmed COVID-19 admitted between November 9, 2020 and February 26, 2021 were retrospectively reviewed. Results: Overall, 41 patients, including 32 KTRs (78%), one kidney-pancreas transplant recipient (2.4%), and 8 LTRs (19.5%) were included. Seven patients (17%) experienced COVID-19 in the first month after transplantation. ⋯ Baseline estimated glomerular filtration rate, respiratory rate on admission, and diabetes mellitus constituted independent risk factors for in-hospital mortality in the KTRs. The LTRs experienced relatively mild COVID-19: only 2 patients (25%) required oxygen supplementation and a single patient (12.5%) died of severe ARDS. Conclusion: In summary, hospitalized KTRs with COVID-19 are at a high risk of acute kidney injury, ARDS, and death.
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Pol. Arch. Med. Wewn. · Nov 2021
Genotype-specific versus pangenotypic regimens in patients infected with HCV genotype 1b in real-world settings.
Introduction: The introduction of direct-acting antivirals (DAAs) has provided us with hope to eliminate hepatitis C virus (HCV) infection as a significant public health problem in the coming years. Objective: Our study aimed to compare the effectiveness and safety of genotype-specific and pangenotypic regimens in genotype 1b–infected patients treated in real-world settings. Patients and methods: Patients were selected from 990 HCV-infected individuals treated with DAAs in the Department of Infectious Diseases in Kielce, Poland, who had the therapy initiated between July 1, 2015 and December 31, 2020. Results: A total of 795 genotype 1b–infected patients with a median age of 51 years, female predominance (55%), and a 21.1% rate of cirrhosis were included in the analysis. A total of 69.9% of patients were treated with genotype-specific regimens. ⋯ Significantly higher proportions of men (P = 0.001) and DAA-experienced patients (P = 0.049) were documented among virologic nonresponders. Conclusions: We confirmed very high effectiveness and a good safety profile of both genotype-specific and pangenotypic regimens used in patients with genotype 1b HCV infection, and we found no differences between these 2 generations of medications. Male sex and previous treatment with DAAs were identified as negative predictors for therapy effectiveness.