Seguimiento a pacientes que asisten al programa de recuperación cardíaca de la IPS salud social en la ciudad de Barranquilla en el año 2017

dc.contributor.advisorNavarro Jiménez, Eduardo
dc.contributor.authorBeleño Cruz, Edinson
dc.contributor.authorMoreno De La Cruz, William
dc.contributor.authorNúñez Olmos, Daniela
dc.date.accessioned2019-02-20T19:44:20Z
dc.date.available2019-02-20T19:44:20Z
dc.date.issued2017
dc.description.abstractAntecedentes: La falla cardiaca es una patología frecuente, de alto costo y que conlleva a complicaciones severas, afecta a cualquier población debido a su etiología diversa, estas incluyen desde alteraciones estructurales hasta estilos de vida, dentro de los síntomas principales se encuentran la falta de aire durante el ejercicio o en reposo, adinamia y signos como taquicardia, taquipnea, hepatomegalia, derrame pleural y estertores pulmonares. Estos se reflejan en la calidad de vida de las personas que la padecen, y afecta a ambos sexos. En este proyecto de investigación se encontrará información referente al seguimiento a pacientes que asisten al programa de recuperación cardíaca y cómo las actividades ejecutadas con ayuda del grupo de especialistas y los diferentes servicios que brinda el Programa como el hospital día tienen una repercusión positiva en la compensación de aquellos pacientes que no lo estén, este seguimiento será medido a partir de los valores de Pro-BNP y la Fracción de eyección ventricular con la que ingresen y el que sea realizado de control, otro de los indicadores será la clase funcional en la que se encuentre el paciente y que permitirá determinar la eficacia del tratamiento, esto se verá reflejado en la disminución de las rehospitalizaciones por descompensación y en la proporción de mortalidad en pacientes pertenecientes al Programa. Objetivos: Realizar seguimiento a pacientes que asisten al programa de recuperación cardíaca de la IPS Salud Social de la ciudad de Barranquilla en el año 2017. Materiales y Métodos: Investigación descriptiva observacional prospectiva: Se realizará la caracterización de la evolución de los pacientes que asisten al Programa de Falla Cardíaca en la IPS Salud Social en la ciudad de Barranquilla durante el año 2017. Investigación de campo: Se realizará en la IPS Salud Social de la ciudad de Barranquilla, en el cual evaluaremos variables cualitativas tales como el género de los pacientes, el Pro-BNP si está normal o alterado, y la clase funcional según la NYHA. Además se evaluarán variables cuantitativas tales como la proporción de pacientes que asisten al Hospital día, la proporción de rehospitalizaciones, de pacientes compensados y de mortalidad. El instrumento de recolección de la información será la base de datos de las historias clínicas de los pacientes que asisten al programa de falla cardíaca de la IPS Salud Social. Resultados: El 58% de los pacientes eran hombres. El 43% de los pacientes tenían edades comprendidas entre 51 a 70 años y el 41% entre 71 y 90 años. El 96% de los pacientes tenían el PRO BNP alterado al inicio del tratamiento. El 75% de los pacientes tenían el PRO BNP alterado a los 6 meses de inicio del tratamiento. Hubo una sobrevida del 98% a los 6 meses de iniciado el tratamiento. Conclusiones: La mortalidad atribuible a la falla cardíaca depende de factores como la severidad, el compromiso de la fracción de eyección, la etiología, el tratamiento y el momento del diagnóstico. El riesgo de muerte a cinco años varía según el estadio; así, para el A es del 3%, para el B es del 4%, para el C es del 25% y para el D es del 80. Los modelos de atención especializados en insuficiencia cardiaca emergen como una estrategia para mejorar el pronóstico de estos pacientes.spa
dc.description.abstractBackground: Heart failure is a frequent pathology, of high cost and that leads to severe complications, affects any population due to its diverse etiology, these include structural alterations to lifestyles, within the main symptoms are the lack of air during exercise or at rest, adynamia and signs such as tachycardia, tachypnea, hepatomegaly, pleural effusion and pulmonary rales. These are reflected in the quality of life of the people who suffer from it, and it affects both sexes. In this research project you will find information regarding the follow-up of patients attending the cardiac recovery program and how the activities carried out with the help of the group of specialists and the different services provided by the Program, such as the day hospital, have a positive impact on compensation of those patients who are not, this follow-up will be measured from the values of Pro-BNP and the fraction of ventricular ejection with which they enter and that which is made of control, another of the indicators will be the functional class in which the patient is located and that will allow to determine the efficacy of the treatment, this will be reflected in the decrease of rehospitalizations due to decompensation and in the proportion of mortality in patients belonging to the Program. Objective: Follow up patients who attend the cardiac recovery program of the IPS Salud Social of the city of Barranquilla in 2017. Materials and Methods: Prospective observational descriptive research: Characterization of the evolution of patients attending the Cardiac Failure Program in the IPS Salud Social in the city of Barranquilla during the year 2017 will be carried out. Field research: It will be carried out in the IPS Social Health of the city of Barranquilla, in which we will evaluate qualitative variables such as the gender of the patients, the Pro-BNP if it is normal or altered, and the functional class according to the NYHA. In addition, quantitative variables such as the proportion of patients attending the day hospital, the proportion of rehospitalizations, compensated patients and mortality will be evaluated. The information collection instrument will be the database of the medical records of patients who attend the IPS Salud Social's heart failure program. Results: 58% of the patients were men. 43% of the patients were between the ages of 51 and 70 and 41% between 71 and 90 years old. 96% of the patients had the PRO BNP altered at the beginning of the treatment. 75% of the patients had the BNP PRO altered at 6 months after starting treatment. There was a 98% survival 6 months after the start of treatment. Conclusions: Mortality attributable to heart failure depends on factors such as severity, ejection fraction compromise, etiology, treatment, and time of diagnosis. The risk of death at five years varies according to the stage; thus, for A it is 3%, for B it is 4%, for C it is 25% and for D it is 80. Specialized attention models in heart failure emerge as a strategy to improve the prognosis of these patients.eng
dc.identifier.urihttp://hdl.handle.net/20.500.12442/2653
dc.language.isospaspa
dc.publisherEdiciones Univerisidad Simón Bolívarspa
dc.publisherFacultad de Ciencias de la Saludspa
dc.rights.accessrightsinfo:eu-repo/semantics/restrictedAccess
dc.rights.licenselicencia de Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional
dc.subjectFalla cardíacaspa
dc.subjectFracción de eyección ventricularspa
dc.subjectPéptido Natriurético tipo Bspa
dc.subjectMortalidad. Hospitalizaciónspa
dc.subjectHeart failureeng
dc.subjectVentricular ejection fractioneng
dc.subjectPeptide Natriuretic type Beng
dc.subjectMortality. Hospitalizationeng
dc.titleSeguimiento a pacientes que asisten al programa de recuperación cardíaca de la IPS salud social en la ciudad de Barranquilla en el año 2017spa
dc.typeOtherspa
dcterms.referencesDarío EA, Gustavo RB. Revista Colombiana de Cardiología, 2016, [Internet]: 2016 Oct;7(8) Available from: http://www.revcolcard.org/assets/revista/VOL23-SUPL1-2016.pdfspa
dcterms.referencesMcMurray JJ, Petrie MC, Murdoch DR, Davie AP. Clinical epidemiology of heart failure: public and private health burden. Eur Heart J [Internet]. 1998 Dec;19 Suppl P:P9-16. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9886707eng
dcterms.referencesMcMurray JJ V, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart. Eur J Heart Fail [Internet]. 2012 Aug;14(8):803–69. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22828712eng
dcterms.referencesWriting committee members, Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation [Internet]. 2013 Oct 15;128(16):e240-327. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23741058eng
dcterms.referencesBuggey J, Mentz RJ, Galanos AN. End-of-life Heart Failure Care in the United States. Heart Fail Clin [Internet]. 2015 Oct;11(4):615–23. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26462101eng
dcterms.referencesHernández-Leiva E. Epidemiología del síndrome coronario agudo y la insuficiencia cardiaca en Latinoamérica. Rev Española Cardiol [Internet]. 2011 Jul;64:34–43. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0300893211006142spa
dcterms.referencesSISPRO. Bodega de datos de SISPRO (RIPS) - Ministerio de Salud y Protección Social. Reporte: prestaciones de servicios de salud reportados por las entidades administradoras de planes de beneficio para los años 2009, 2010 y 2011.spa
dcterms.referencesYancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147--- 239.eng
dcterms.referencesPani L, Pecorelli S, Rosano G, Anker SD, Peracino A, Fregonese L, et al. Steps forward in regulatory pathways for acute and chronic heart failure. Eur J Heart Fail [Internet]. 2015 Jan;17(1):3–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25597869eng
dcterms.referencesJessup M, Brozena S. Heart failure. N Engl J Med [Internet]. 2003 May 15;348(20):2007–18. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12748317eng
dcterms.referencesRevista Colombiana de Cardiologia. Edición 23. 5 de febrero de 2016. Pag (7-12.) Disponible en: http://www.revcolcard.org/assets/revista/VOL23 SUPL1 2016.pdfspa
dcterms.referencesTamayo D, Rodríguez V, Rojas M, Rincón M, Franco C, Ibarra M, et al. Costos ambulatorios y hospitalarios de la falla cardiaca en dos hospitales de Bogotá. Acta Med Colomb. 2013;38:208---12.spa
dcterms.referencesSISPRO. Bodega de datos de SISPRO (RIPS) - Ministerio de Salud y Protección Social. Reporte: prestaciones de servicios de salud reportados por las entidades administradoras de planes de beneficio para los años 2009, 2010 y 2011, según resolución 3374/00. Actualización a 31-01-2013spa
dcterms.referencesOspina A, Gamarra G. Características clínicas y epidemiológicas de la insuficiencia cardiaca en el Hospital Universitario Ramón González Valencia de Bucaramanga, Colombia. Revista Salud UIS, [S.l.]. 2010; 36(3). Disponible en: http://revistas.uis.edu.co/index.php/revistasaluduis/article/ view/629spa
dcterms.referencesNavarro Jimenez E, Aroca Martínez G, Santos D. Implementación de un modelo de salud renal en red informática para la temprana detección y cuidado de la nefropatía primaria lúpica y glomerulonefritis en la Región Caribe Colombiana. Rev Colomb Nefrol [Internet]. 2014;1. Available from: http://www.revistanefrologia.org/index.php/rcn/article/view/145spa
dcterms.referencesNavarro-Jimenez EI, Aroca Martínez G, Castillo LA, Gonzalez-Torres H. Membranoproliferative Glomerulonephritis C3 Deposits: Clinicopathological Study. J Am Soc Nephrol. 2015.spa
dcterms.referencesCastillo Parodi L, Navarro Jiménez E, Arango Quiroz Y, López Avendaño A, Mejía Varela V, González Torres HJ, et al. Obesity Association with Chronic Renal Disease in Patients attended at Clínica de la Costa. Barranquilla, Colombia. 2005-2014. Rev Colomb Nefrol [Internet]. 2016 Jan 1;3(1):14–9. Available from: http://www.revistanefrologia.org/index.php/rcn/article/view/217/pdfeng
dcterms.referencesPonikowski P, Voors A, Anker S, Bueno H, Cleland J, Coats A, Falk V,Gonza´lez-Juanatey, Harjola P, Jankowska E, 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Society of Cardiology (ESC) 26 de mayo de 2016. Pag 2. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/27206819eng
dcterms.referencesMosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart [Internet]. 2007 Sep;93(9):1137–46. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17699180eng
dcterms.referencesCeia F, Fonseca C, Mota T, Morais H, Matias F, de Sousa A, et al. Prevalence of chronic heart failure in Southwestern Europe: the EPICA study. Eur J Heart Fail [Internet]. 2002 Aug;4(4):531–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12167394eng
dcterms.referencesvan Riet EES, Hoes AW, Limburg A, Landman MAJ, van der Hoeven H, Rutten FH. Prevalence of unrecognized heart failure in older persons with shortness of breath on exertion. Eur J Heart Fail [Internet]. 2014 Jul;16(7):772–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24863953eng
dcterms.referencesClark AL. Instrumental activities of daily living: more than just piano-playing? Eur J Heart Fail [Internet]. 2012 Jun;14(6):565–6. Available from: http://doi.wiley.com/10.1093/eurjhf/hfs065eng
dcterms.referencesBleumink GS, Knetsch AM, Sturkenboom MCJM, Straus SMJM, Hofman A, Deckers JW, et al. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure The Rotterdam Study. Eur Heart J [Internet]. 2004 Sep;25(18):1614–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15351160eng
dcterms.referencesGerber Y, Weston SA, Redfield MM, Chamberlain AM, Manemann SM, Jiang R, et al. A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010. JAMA Intern Med [Internet]. 2015 Jun;175(6):996–1004. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25895156eng
dcterms.referencesMurdoch DR, Love MP, Robb SD, McDonagh TA, Davie AP, Ford I, et al. Importance of heart failure as a cause of death. Changing contribution to overall mortality and coronary heart Dickstein K et al. Guía de práctica clínica de la Sociedad Europea de Cardiología (ESC) para el diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica (2008) Rev Esp Cardiol. 2008;61(12):1329.e1-1329.e70 63e disease mortality in Scotland 1979-1992. Eur Heart J. 1998;19:1829-35eng
dcterms.referencesLazarev V V. [Electroencephalographic characteristics of intellectual activity in astheno-adynamic subdepressions]. Zh Nevropatol Psikhiatr Im S S Korsakova [Internet]. 1986;86(12):1807–13. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3825369eng
dcterms.referencesDavie AP, Francis CM, Caruana L, Sutherland GR, McMurray JJ. Assessing diagnosis in heart failure: which features are any use? QJM [Internet]. 1997 May;90(5):335–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9205668eng
dcterms.referencesKelder JC, Cramer MJ, van Wijngaarden J, van Tooren R, Mosterd A, Moons KGM, et al. The diagnostic value of physical examination and additional testing in primary care patients with suspected heart failure. Circulation [Internet]. 2011 Dec 20;124(25):2865–73. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22104551eng
dcterms.referencesRitova V V, Larionov AS. [The association of staphylococci with respiratory viruses in acute pneumonia]. Zh Mikrobiol Epidemiol Immunobiol [Internet]. 1966 Nov;43(11):74–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/4309072eng
dcterms.referencesWong CM, Hawkins NM, Petrie MC, Jhund PS, Gardner RS, Ariti CA, et al. Heart failure in younger patients: the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC). Eur Heart J [Internet]. 2014 Oct 14;35(39):2714–21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24944329eng
dcterms.referencesBoonman-de Winter LJM, Rutten FH, Cramer MJ, Landman MJ, Zuithoff NPA, Liem AH, et al. Efficiently screening heart failure in patients with type 2 diabetes. Eur J Heart Fail [Internet]. 2015 Feb;17(2):187–95. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25557025eng
dcterms.referencesPonikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail [Internet]. 2016 Aug;18(8):891–975. Available from: http://doi.wiley.com/10.1002/ejhf.592eng
dcterms.referencesButler J, Fonarow GC, Zile MR, Lam CS, Roessig L, Schelbert EB, et al. Developing therapies for heart failure with preserved ejection fraction: currentstate and future directions. JACC Heart Fail [Internet]. 2014 Apr;2(2):97–112. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24720916eng
dcterms.referencesHeart Failure Society of America (HFSA) practice guidelines. HFSA guidelines for management of patients with heart failure caused by left ventricular systolic dysfunction--pharmacological approaches. J Card Fail [Internet]. 1999 Dec;5(4):357–82. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10634677eng
dcterms.referencesRevista Colombiana de Cardiología. Edición 23. 5 de febrero de 2016. Pag (7-12.) Disponible en: http://www.revcolcard.org/assets/revista/VOL23-SUPL1- 2016.pdf 0120-5633/ http://dx.doi.org/10.1016/j.rccar.2016.01.002spa
dcterms.referencesRoig E, Pérez-Villa F, Cuppoletti A, Castillo M, Hernández N, Morales M, et al. Programa de atención especializada en la insuficiencia cardíaca terminal. Experiencia piloto de una unidad de insuficiencia cardíaca. Rev Española Cardiol [Internet]. 2006 Feb;59(2):109–16. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0300893206745997spa
dcterms.referencesComín-Colet J, Verdú-Rotellar JM, Vela E, Clèries M, Bustins M, Mendoza L, et al. Eficacia de un programa integrado hospital-atención primaria para la insuficiencia cardiaca: análisis poblacional sobre 56.742 pacientes. Rev Española Cardiol [Internet]. 2014 Apr;67(4):283–93. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0300893214000359spa
dcterms.referencesInglis SC, Clark RA, McAlister FA, Ball J, Lewinter C, Cullington D, et al. Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane database Syst Rev [Internet]. 2010 Aug 4;(8):CD007228. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20687083eng
dcterms.referencesMaisel A, Mueller C, Adams K, Anker SD, Aspromonte N, Cleland JGF, et al. State of the art: using natriuretic peptide levels in clinical practice. Eur J Heart Fail [Internet]. 2008 Sep;10(9):824–39. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18760965eng
dcterms.referencesBertens LCM, Broekhuizen BDL, Naaktgeboren CA, Rutten FH, Hoes AW, van Mourik Y, et al. Use of Expert Panels to Define the Reference Standard in Diagnostic Research: A Systematic Review of Published Methods and Reporting. Ghersi D, editor. PLoS Med [Internet]. 2013 Oct 15;10(10):e1001531. Available from: http://dx.plos.org/10.1371/journal.pmed.1001531eng
dcterms.referencesZaphiriou A, Robb S, Murray-Thomas T, Mendez G, Fox K, McDonagh T, et al. The diagnostic accuracy of plasma BNP and NTproBNP in patients referred from primary care with suspected heart failure: results of the UK natriuretic peptide study. Eur J Heart Fail [Internet]. 2005 Jun;7(4):537–41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15921792eng
dcterms.referencesPaulus WJ, Tschöpe C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J [Internet]. 2007 Oct;28(20):2539–50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17428822eng
dcterms.referencesVoigt J-U, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. J Am Soc Echocardiogr [Internet]. 2015 Feb;28(2):183–93. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25623220eng
dcterms.referencesvan Riet EES, Hoes AW, Limburg A, Landman MAJ, van der Hoeven H, Rutten FH. Prevalence of unrecognized heart failure in older persons with shortness of breath on exertion. Eur J Heart Fail [Internet]. 2014 Jul;16(7):772–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24863953eng
dcterms.referencesThomas JT, Kelly RF, Thomas SJ, Stamos TD, Albasha K, Parrillo JE, et al. Utility of history, physical examination, electrocardiogram, and chest radiograph for differentiating normal from decreased systolic function in patients with heart failure. Am J Med [Internet]. 2002 Apr 15;112(6):437–45. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11959053eng
dcterms.referencesGarg R, Yusuf S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials. JAMA [Internet]. 1995 May 10;273(18):1450–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7654275eng
dcterms.referencesMaggioni AP, Anker SD, Dahlström U, Filippatos G, Ponikowski P, Zannad F, et al. Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail [Internet]. 2013 Oct;15(10):1173–84. Available from: http://doi.wiley.com/10.1093/eurjhf/hft134eng
dcterms.referencesHjalmarson A, Goldstein S, Fagerberg B, Wedel H, Waagstein F, Kjekshus J, et al. Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF). MERIT-HF Study Group. JAMA [Internet]. 2000 Mar 8;283(10):1295–302. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10714728eng
dcterms.referencesPacker M, Coats AJ, Fowler MB, Katus HA, Krum H, Mohacsi P, et al. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med [Internet]. 2001 May 31;344(22):1651–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11386263eng
dcterms.referencesFlather MD, Shibata MC, Coats AJS, Van Veldhuisen DJ, Parkhomenko A, Borbola J, et al. Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J [Internet]. 2005 Feb;26(3):215–25. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15642700eng
dcterms.referencesZannad F, McMurray JJ V, Krum H, van Veldhuisen DJ, Swedberg K, Shi H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med [Internet]. 2011 Jan 6;364(1):11–21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21073363eng
dcterms.referencesFaris R, Flather MD, Purcell H, Poole-Wilson PA, Coats AJS. Diuretics for heart failure. Cochrane database Syst Rev [Internet]. 2006 Jan 25;(1):CD003838. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16437464eng
dcterms.referencesRodríguez Villanueva J, Alsar MJ, Avendaño C, Gómez-Piqueras C, García Alonso F. Estudios farmacogenéticos: guía de evaluación para Comités Éticos de Investigación Clínica. Fundamentos científicos y marco legal (I). Med Clin (Barc) 2003; 120: 63-67spa
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