doctor Vicente Arrarte and Dr. Ana Zugasti, members of the Spanish Society of Cardiology and the Spanish Society of Endocrinology and Nutrition
The prevalence of cardiac insufficiency (CI) in Spain is 1.89% of the population aged 18 years and over, reaching 770,000 patients. There are many factors related to HF; In case of obesity, the risk of HF increases by at least 5 to 7% for each point added to the body mass index. The document for the detection and management of HF in people with obesity seeks to register the tests to be requested in an orderly manner in primary care, in endocrinology consultations and in all those in which they are evaluated. The symptoms and signs are fundamental in the detection for an adequate diagnosis, but no less important is the assessment of the probability of developing HF taking into account the comorbidities associated with each patient.
Likewise, special attention should be given to data from diagnostic tests that aid in screening and diagnosis, such as the electrocardiogram, natriuretic peptides obtained from blood tests or imaging techniques such as echocardiography. The main general recommendations on changes in eating habits, individual exercise prescription, control of associated comorbidities in each patient and the possible prescription of drugs that have shown benefits in the prevention and symptomatic control of patients with obesity and heart failure.
It is a priority to differentiate, due to the different evidence data, those patients with heart failure with preserved ejection fraction or with heart failure with reduced ejection fraction
In this last point, it is a priority to differentiate, due to the different evidence data, those patients with heart failure with preserved ejection fraction or with heart failure with reduced ejection fraction, as the treatment will vary as specified in the document.
On the other hand, following the importance of associated comorbidities in patients with HF, about 20% have Disease Related Malnutrition (DRE), pathology that worsens both the prognosis and the quality of life. Additionally, heart failure can lead to sarcopenia (a condition that causes loss of muscle strength, mass, and function). Faced with this magnitude, and with the possibility of early diagnosis and improved prognosis for both EDR and sarcopenia, both scientific societies jointly developed a consensus that facilitates coordinated, multi- and interdisciplinary care.
This document is intended to be very useful for detection and initial management in cardiac rehabilitation teams, but its dissemination and use by other specialists is recommended. Once the EDR and/or sarcopenia is detected, the endocrinologist is the specialist doctor qualified to perform a morphofunctional assessment and adjust the medical-nutritional treatment required by the patient with heart failure. They are patients with complex pathologies, which require progressive adjustments of medication, as well as nutritional treatment.
The patient must understand that the dietary and physical exercise recommendations must be maintained in the long term, as the affectation is not limited to the heart.
In this regard, the minimum recommended caloric and protein intake (27 kcal/kg/day and 1.5 g/protein/kg/day) should be highlighted, in the context of a Mediterranean dietary pattern and with an adequate distribution throughout the diet. . of the day that allows an adequate protein synthesis. Also, they can be accurate vitamin, mineral and nutritional supplements and even enteral or parenteral nutrition.
The patient must understand that the dietary and physical exercise recommendations must be maintained in the long term, as the affectation is not limited to the heart, but it is the metabolic and functional status of the body that will determine its survival and quality of life. . .life. Consensus documents propose which tests should be requested in endocrinology and cardiology consultations in the face of suspicious symptoms and signs. They also include a global approach to risk factors and outline initial treatment as well as referral and coordination between the two services.