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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Heart failure &#40;HF&#41; continues to be a major burden on public health systems&#44; with high morbidity and mortality and spiraling costs&#44; which account for 1&#8211;2&#37; of the annual health budget of most developed nations&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">1</span></a> In Spain&#44; it is the third leading cause of death from cardiovascular disease&#59; ischemic heart disease and cerebrovascular disease are the leading causes&#44; with estimated mortality of 4&#46;2&#37; and 4&#46;4&#37; for the years 2010 and 2011&#44; respectively&#46; Moreover&#44; HF is the primary cause of hospitalization in patients aged 65 or over&#44; accounting for 2&#8211;2&#46;5&#37; of the total number of annual hospital admissions&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">2</span></a> Furthermore&#44; the readmission rate following a first hospitalization for HF is high&#44; increasing from 38&#37; in the first month<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">3</span></a> to 43&#37; at 6&#8211;12 months&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The prevalence of HF is on the rise due not only to the improved prognosis of patients with ischemic heart disease &#40;IHD&#41; or hypertension&#44; but also to the progressive aging of the population&#46; The census for the Spanish population for the last two decades showed an increase of nearly 50&#37; in life expectancy of 1&#8211;2 years in the population aged from 77 to 87 years&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">2</span></a> Moreover&#44; the prevalence of HF is estimated at 6&#46;8&#37; in people aged 45 years or older&#44; and 16&#46;1&#37; in people older than 75&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">5</span></a> and it is precisely in the latter population that the incidence and prevalence of heart failure with preserved ejection fraction &#40;HFPEF&#41; rises&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Though the survival of HF patients has improved in recent years&#44; prognosis continues to be poor&#44; with 50&#37; mortality five years after diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">7</span></a> Most clinical trials are on patients with heart failure with reduced ejection fraction &#40;HFREF&#41;&#44; and it is in this population that current therapies have shown to improve life expectancy&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">8</span></a> In contrast&#44; the findings on HFPEF remain inconclusive&#44; which underscores the need for further studies on these patients&#44; who are the most prevalent among elderly populations&#44; as most internal medicine departments can attest&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Few studies have compared the clinical characteristics of elderly patients with HFREF in comparison to those with HFPEF&#46; The aim of this study was to assess prevalence&#44; clinical characteristics&#44; and medium-term prognosis of a group of elderly HFPEF patients in comparison to elderly HFREF patients who were followed in an internal medicine unit&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a retrospective observational study of a cohort of 301 patients who were followed in an internal medicine unit HF unit in a tertiary referral hospital in north-eastern Spain with an estimated catchment population of 400 000&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">10</span></a> Patients were consecutively included for study between January 1&#44; 2007 and December 31&#44; 2010&#44; and their vital status was checked to determine whether they were alive on December 31&#44; 2012&#46; Patients were referred from primary health care&#44; emergency departments&#44; and cardiology and internal medicine wards&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Only patients aged 18 years or older were included in the study&#46; HF was diagnosed according to the clinical practice guidelines of the European Cardiology Society<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">11</span></a> and the American College of Cardiology&#47;American Heart Association&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">12</span></a> based on the presence of HF symptoms and signs&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">At the time of inclusion and during follow-up&#44; data were collected on sociodemographic&#44; clinical&#44; laboratory&#44; electrocardiographic&#44; and echocardiographic variables&#44; New York Heart Association &#40;NYHA&#41; functional class&#44; and treatment&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Left ventricular ejection fraction &#40;LVEF&#41; was measured using the Teichholz formula and the subjective scoring of the echocardiographer&#46; Patients were assigned to one of two groups&#58; preserved ejection fraction with LVEF &#8805;50&#37;&#44; or reduced ejection fraction with LVEF &#60;50&#37;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Hypertension was defined as blood pressure &#62;140&#47;90 mmHg or less if under directed treatment&#44; anemia as hemoglobin &#60;12 g&#47;dl for women and &#60;13 g&#47;dl for men&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">13</span></a> and chronic renal disease as a glomerular filtration rate &#60;60 ml&#47;min&#47;m<span class="elsevierStyleSup">2</span> using the 4-variable Modification of Diet in Renal Disease formula&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The etiology of HF was determined on the basis of the following criteria&#58; ischemic&#44; when the patient was diagnosed with IHD&#59; valvular&#44; when there was moderate valvulopathy with no IHD&#59; hypertensive&#44; when there was known hypertension but no evidence of other significant heart disease&#59; dilated cardiomyopathy&#44; as defined by LVEF &#60;50&#37; with no other known cardiac cause &#40;including heavy drinking&#44; idiopathic etiology&#44; etc&#46;&#41;&#59; cor pulmonale&#44; right heart failure without left ventricular dysfunction&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Qualitative variables were expressed as absolute frequencies and percentages and quantitative variables were expressed as mean &#177; standard deviation&#46; The statistical analysis was performed using SPSS for Windows&#44; version 15&#46; Descriptive statistical analysis was based on frequency tables of categorical variables using the chi-square test to compare the significance of association between qualitative variables&#46; The Student&#39;s t test for independent samples was used to compare quantitative variables&#46; A value of p&#60;0&#46;05 &#40;two-sided&#41; was used as the nominal level of statistical significance&#46; Survival curves between the HFREF and HFPEF patient groups were constructed using the Kaplan-Meier method and compared using the log-rank test&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">A total of 301 patients were assessed&#44; of whom 165 &#40;54&#46;8&#37;&#41; were women&#46; For various reasons &#40;including non-compliance with follow-up and unfavorable clinical conditions&#41;&#44; LVEF was not assessed echocardiographically in 38 patients &#40;12&#46;7&#37;&#41;&#46; Of the 263 &#40;87&#46;4&#37;&#41; patients in whom LVEF was assessed echocardiographically&#44; 190 &#40;72&#46;2&#37;&#41; had HFPEF and 73 &#40;27&#46;8&#37;&#41; had HFREF&#46; The characteristics of the two groups are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Patients&#8217; mean age was similar in the two groups &#40;80&#46;1 and 79&#46;9 years&#59; p&#61;0&#46;905&#41;&#44; with a predominance of women in the HFPEF group &#40;60&#46;5&#37; women&#44; 42&#46;5&#37; men&#41;&#46; Analysis of cardiovascular risk factors such as hypertension and diabetes&#44; other comorbidities including chronic obstructive pulmonary disease&#44; anemia&#44; atrial fibrillation&#44; and chronic renal disease&#44; and NYHA functional class revealed no statistically significant differences&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Regarding etiology&#44; hypertensive heart disease was the main cause in the HFPEF group&#44; whereas IHD and dilated cardiomyopathy were the main causes in the HFREF group&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Data on patient referral source&#44; pharmacological treatment for LVEF&#44; and follow-up are shown in <a class="elsevierStyleCrossRefs" href="#tbl0025">Tables 2&#8211;4</a>&#44; respectively&#46;Most referrals from internal medicine wards had HFPEF&#44; whereas most referrals from cardiology wards had HFREF &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 2</a>&#41;&#46; Comparison of treatments during follow-up showed no significant differences in the use of angiotensin-converting enzyme &#40;ACE&#41; inhibitors&#44; angiotensin receptor blockers &#40;ARBs&#41;&#44; and aldosterone antagonists &#40;AA&#41;&#46; HFREF patients were prescribed more beta-blockers than HFPEF patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0045">Table 3</a>&#41;&#46; The mean follow-up was 10 months&#46; No statistically significant differences in survival rates&#44; follow-up or causes of ending of the observation period were found between the groups according to LVEF &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0045"></elsevierMultimedia><elsevierMultimedia ident="tbl0065"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">This study confirmed that HFPEF is more frequent in elderly patients&#46; In our series 72&#46;2&#37; of HFPEF patients had a mean age &#62;80 years&#46; In other studies&#44; its frequency varies considerably&#44; with 51&#46;8&#37; of cases at a mean age of 72&#46;4 years&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">9</span></a> and 40&#37; at a mean age of 66 years&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">14</span></a> These differences are in all likelihood due to differences in age&#44; as the patients in this study were older than in most series in the recent literature&#44; which would account for the lower percentages of patients with preserved LVEF&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">14&#8211;20</span></a> In contrast&#44; other studies including very elderly patients report mean ages similar to those observed in our study&#44; e&#46;g&#46; mean age 80&#177;10 years<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">21</span></a> or close to 79 years&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">22</span></a> However&#44; two other Spanish studies&#44; GALICAP<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">17</span></a> and INCA&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">18</span></a> which included younger patients than in our study &#40;mean age 76 and 71 years&#44; respectively&#41;&#44; found a prevalence of HFPEF similar to that observed in this study&#58; 61&#46;4 and 61&#46;7&#37;&#44; respectively&#46; Likewise&#44; similar results have been obtained in studies undertaken in other countries&#44; such as a prospective study in France&#44; where 61&#37; of the population aged over 80 years had preserved LVEF&#44; falling to 53&#37; below this age group&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">23</span></a> which is similar to the findings of the present study&#46; In contrast&#44; in a Japanese registry of younger patients &#40;mean age 71 years&#41; hospitalized due to HF&#44; only 26&#37; had LVEF &#62;50&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">24</span></a> a similar prevalence to that recorded in another Japanese registry during the years 2000&#8211;2004&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">25</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Though 12&#46;7&#37; of patients were not echocardiographically assessed in our study&#44; this percentage was lower than in other series&#44; even when patients managed by cardiologists were included in the series&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">26&#44;27</span></a> However&#44; other studies have demonstrated that the number of patients without an echocardiogram is relevant in the elderly and in women&#44; since these subgroups present the highest frequency of HFPEF&#44; which suggests that in all probability the true prevalence is underestimated&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">As for gender&#44; in this series women predominated in the HFPEF group &#40;60&#46;5&#37; vs&#46; 42&#46;5&#37; men&#41;&#44; which is in accordance with most previous studies on these patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">9&#44;28</span></a> With respect to etiology&#44; a significant difference was observed between the groups&#58; hypertensive heart disease was the most frequent etiology in the HFPEF group&#44; whereas IHD was the most frequent etiology in the HFREF group&#44; and it is widely acknowledged that the two types of HF differ in their epidemiological characteristics&#46; Thus&#44; HFPEF patients tend to be older and predominantly women&#44; and the main etiology is hypertensive&#44; with less heart disease and atrial fibrillation as concomitant pathologies&#46;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">28&#44;29</span></a> Analysis of NYHA functional class showed no significant differences in cardiovascular risk factors or other comorbidities between the groups&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In terms of drug treatment&#44; 32&#37; of patients received ACE inhibitors&#44; 47&#37; ARBs &#40;ACE inhibitors and ARBs 79&#37;&#41;&#44; 25&#37; AA&#44; and 54&#37; beta-blockers &#40;BBs&#41;&#46; According to other studies&#44; these drug groups can be considered an optimum complement to HF treatment&#44; since they increase survival in HF patients with reduced LVEF&#46; Thus&#44; in an observational retrospective study on compliance with treatment guidelines in elderly Korean HF patients &#40;mean age 76 years&#44; of whom 64&#37; were older than 75 years&#41; by Kim et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">30</span></a> 32&#37; were treated with BBs&#44; 55&#37; with ACE inhibitors or ARBs&#44; and 7&#37; with AA&#46; The type and proportion of drugs administered in our population was similar to other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">9&#44;15&#44;31</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Few studies have assessed the different drug treatments for the two types of HF&#46; As expected&#44; in this study BBs were employed more in HFREF patients&#44; but no significant differences were found between the groups in other treatments&#46; By contrast&#44; a study on 12 000 patients found ACE inhibitors and BBs were employed more in the HFPEF group&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">9</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Despite the lack of evidence for the use of AA in HFPEF&#44; these drugs were prescribed in a high percentage of our patients &#40;22&#46;8&#37;&#41; compared with other studies<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">30</span></a> in order to control congestive symptoms&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Though a wide spectrum of drug groups &#40;ACE inhibitors&#44; ARBs&#44; BBs&#44; and AA&#41; are known to reduce morbidity and mortality in HFREF patients&#44; findings on the benefits of certain HFPEF drug treatments remain inconclusive&#44; which would explain the lack of specific treatment guidelines for these patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">32&#8211;34</span></a>With regard to prognosis&#44; there is disagreement in recent reviews in the literature as to whether the prognosis of HFPEF patients is similar&#44; worse or better than in HFREF patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">35&#8211;37</span></a> Few studies have compared prognosis in the two groups&#44; and fewer still in HFPEF&#44; and the results have been contradictory&#46; While the prognosis of HFPEF patients appears to be better than in HFREF patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">29&#44;38&#44;39</span></a> an observational study on 478 HF patients with atrial fibrillation showed similar mortality for both HFPEF and HFREF &#40;50&#37; vs&#46; 48&#37;&#44; p&#61;0&#46;74&#41; at five years&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">40</span></a> Likewise&#44; other studies have reported similar prognosis in the two groups&#44;<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">41&#44;42</span></a> as was the case in our series&#44; in which no significant differences were found&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In terms of mortality&#44; it is generally believed that prognosis for HFREF is worse than for HFPEF&#44; independently of other factors such as female gender&#44; age&#44; atrial fibrillation&#44; chronic renal disease&#44; functional class &#40;NYHA III or IV&#41;&#44; and pulmonary hypertension&#46;<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">35&#44;43</span></a> In the present series&#44; no significant differences were found in terms of prognosis&#44; but mortality was slightly higher in HFPEF patients&#44; which may be due to other factors such as those mentioned above&#46; Moreover&#44; no significant differences were found between the groups in chronic renal disease&#44; functional class&#44; or age&#46; Given that no differences in mortality between the groups were observed&#44; i&#46;e&#46;&#44; the factors under assessment were evenly distributed in both groups&#44; it would be plausible to expect mortality also to be similar&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In order to improve prognosis&#44; an integrated approach to elderly HF patients is recommended&#44; ideally in specialized units with multidisciplinary teams&#44; as is the case of our specialized HF unit&#44; in which the characteristics of patients are different from those treated by cardiologists &#40;younger and predominantly with HFREF&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In our catchment area&#44; a heart failure protocol was recently designed&#44;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">44</span></a> with the consensus of different specialists &#40;internists and cardiologists&#41;&#44; primary health care&#44; emergency departments&#44; and nursing&#46; The protocol defines the roles of and interaction between the different health care professionals involved in treating and managing HF patients&#44; as well as highlighting the importance of educating patients&#44; health staff&#44; and carers as to treatment compliance and of close and continued follow-up in accordance with the clinical practice guidelines&#44; in order to improve the prognosis and quality of life of these patients&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Limitations</span><p id="par0135" class="elsevierStylePara elsevierViewall">One of the limitations of this study is that all of the patients included in the sample were followed by the internal medicine department&#44; and patients followed by cardiologists were excluded&#46; This may have led to bias in the selection process&#44; given that these patients were older and had less coronary disease&#46; Nevertheless&#44; it results in greater homogeneity in clinical management and treatment in internal medicine departments and in primary health care&#44; both of which are traditionally involved in the management of elderly patients with more comorbidities&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The follow-up period was quite short &#40;10 months&#41; due to the age of our patients&#59; almost half of our sample &#40;42&#37;&#41; died or dropped out during this period&#46; Nevertheless&#44; we would point out that the follow-up was probably sufficiently long&#44; given the characteristics of our cohort&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">A further limitation is the exclusion of the nearly 13&#37; of patients who were not echocardiographically assessed&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusion</span><p id="par0150" class="elsevierStylePara elsevierViewall">In this study&#44; most patients presented HFPEF&#46; The clinical characteristics of this group were similar to those of the HFREF group&#46; As in other studies&#44; women and hypertensive etiology were predominant in the HFPEF group&#46; HFREF patients were more likely to receive BBs&#44; and dilated cardiomyopathy predominated&#46; No significant differences in mortality were observed between the groups&#46; Our experience shows that an integrated multidisciplinary approach enhances the treatment&#44; management&#44; and follow-up of HF patients&#46; However&#44; few studies have focused on HFPEF patients&#44; and even fewer have included patients from internists in specialized HF units&#44; which underscores the need for further prospective studies to explore new improved therapeutic strategies&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical disclosures</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Protection of human and animal subjects</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Confidentiality of data</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Right to privacy and informed consent</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to assess prevalence&#44; clinical characteristics&#44; and prognosis in elderly patients with heart failure with preserved ejection fraction &#40;HFPEF&#41; compared to patients with heart failure with reduced ejection fraction &#40;HFREF&#41; who were followed in an internal medicine unit&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In this retrospective observational study&#44; the sample consisted of 301 patients followed in an internal medicine referral unit between January 2007 and December 2010&#46; All patients were checked to determine their vital status on 31 December 2012&#46; Survival was analyzed using Kaplan-Meier curves&#44; and compared using the log-rank test&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of the 301 patients&#44; 165 &#40;54&#46;8&#37;&#41; were women&#46; In the 263 cases &#40;87&#46;4&#37;&#41; who underwent echocardiographic assessment&#44; 190 &#40;72&#46;2&#37;&#41; had HFPEF and 73 &#40;27&#46;8&#37;&#41; had HFREF&#46; Mean age was similar in the two groups &#40;80&#46;1 and 79&#46;9 years&#59; p&#61;0&#46;905&#41;&#44; with a predominance of women in the HFPEF group &#40;60&#46;5&#37; women&#44; 42&#46;5&#37; men&#59; p&#61;0&#46;025&#41;&#46; The main etiology was hypertensive heart disease in the HFPEF group&#46; Regarding treatment&#44; more beta-blockers were administered in the HFREF group&#46; No statistically significant differences were observed between the groups in terms of cardiovascular risk factors&#44; comorbidities&#44; NYHA functional class&#44; or mortality&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics were similar for both HFPEF and HFREF patients&#46; Women were predominant in the HFPEF group&#44; as was hypertensive etiology&#46; No significant differences in mortality were observed between the groups&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">O objetivo do estudo &#233; analisar a preval&#234;ncia&#44; as caracter&#237;sticas cl&#237;nicas e o progn&#243;stico dum grupo de doentes idosos com diagn&#243;stico de insufici&#234;ncia card&#237;aca com fra&#231;&#227;o de eje&#231;&#227;o preservada &#40;IC&#47;FEP&#41; seguidos numa consulta especializada e compar&#225;-los com os doentes que apresentam fra&#231;&#227;o de eje&#231;&#227;o dimu&#237;da &#40;IC&#47;FED&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiais e m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo retrospetivo observacional incluindo 301 doentes&#44; seguidos numa consulta especializada de Medicina Interna&#44; no per&#237;odo entre janeiro de 2007 e dezembro de 2010 cujo <span class="elsevierStyleItalic">status</span> vital foi determinado a 31 de dezembro de 2012&#46; Para a an&#225;lise de sobreviv&#234;ncia foram utilizadas as curvas de Kaplan-Meier e na compara&#231;&#227;o foi utilizado o teste de Log-rank&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">301 doentes foram estudados&#44; sendo 165 &#40;54&#44;8&#37;&#41; do sexo feminino&#46; Nos 263 &#40;87&#44;4&#37;&#41; casos nos quais foi realizado o estudo ecocardiogr&#225;fico&#44; 190 &#40;72&#44;2&#37;&#41; correspondiam a doentes com diagn&#243;stico de IC&#47;FEP e 73 &#40;27&#44;8&#37;&#41; de IC&#47;FED&#46; A idade m&#233;dia foi similar nos dois grupos &#40;80&#44;3 e 79&#44;9 anos&#44; p 0&#44;905&#41;&#44; sendo maior a percentagem de mulheres &#40;60&#44;5&#37; face a 42&#44;5&#37;&#44; p 0&#44;025&#41; e com predom&#237;nio de etiologia hipertensiva no grupo com IC&#47;FEP&#46; Quanto ao tratamento&#44; o uso de betabloqueantes foi maior no grupo com IC&#47;FED&#46; N&#227;o foram encontradas diferen&#231;as significativas entre ambos os grupos relativamente a fatores de risco cardiovascular&#44; comorbilidades&#44; classe funcional ou mortalidade&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">As carater&#237;sticas cl&#237;nicas dos doentes com IC&#47;FEP e com IC&#47;FED s&#227;o similares&#46; No grupo de IC&#47;FEP predominam os doentes do sexo feminino e a etiologia hipertensiva&#46; N&#227;o foram observadas diferen&#231;as na mortalidade entre ambos os grupos&#46;</p></span>"
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            "identificador" => "abst0025"
            "titulo" => "Introdu&#231;&#227;o e objetivos"
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            "identificador" => "abst0030"
            "titulo" => "Materiais e m&#233;todos"
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          3 => array:2 [
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            "titulo" => "Conclus&#227;o"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Follow-up survival curve for patients with heart failure with preserved ejection fraction and heart failure with reduced ejection fraction&#46;</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">COPD&#58; chronic obstructive pulmonary disease&#59; DCM&#58; dilated cardiomyopathy&#59; LVEF&#58; left ventricular ejection fraction&#59; NYHA&#58; New York Heart Association&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Overall &#40;n&#61;301&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LVEF &#8805;50&#37; &#40;n&#61;190&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LVEF &#60;50&#37; &#40;n&#61;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Women&#44; &#37; &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#46;8 &#40;165&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;5 &#40;115&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;5 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;025&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; years &#40;P25&#59;75&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#46;3 &#40;75&#46;2&#59;84&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#46;1 &#40;74&#46;6&#59;84&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#46;9 &#40;74&#46;0&#59;84&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;905&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">COPD&#44; &#37; &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;2 &#40;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;6 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;8 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;773&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Diabetes&#44; &#37; &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;2 &#40;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;2 &#40;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;1 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;892&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Hypertension&#44; &#37; &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#46;4 &#40;245&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#46;2 &#40;160&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#46;7 &#40;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;259&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Anemia&#44; &#37; &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#46;8 &#40;141&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#46;3 &#40;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;9 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;692&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Renal failure&#44; &#37; &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#46;8 &#40;177&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;4 &#40;109&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#46;9 &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;629&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">NYHA class&#44; &#37; &#40;n&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;8 &#40;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;5 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;1 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;792&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;5 &#40;127&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;8 &#40;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#46;6 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;792&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;1 &#40;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;7 &#40;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;3 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;792&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;792&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Atrial fibrillation&#44; &#37; &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;1 &#40;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;8 &#40;106&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;2 &#40;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;791&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Etiology&#44; &#37; &#40;n&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypertensive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;8 &#40;198&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#46;5 &#40;129&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;5 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ischemic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;0 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;4 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;8 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Valvular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;6 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;8 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>DCM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;5 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;3 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cor pulmonale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;1 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;1 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;1 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;1 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics of patients according to left ventricular ejection fraction&#46;</p>"
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        "identificador" => "tbl0025"
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">LVEF&#58; left ventricular ejection fraction&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Overall &#40;n&#61;301&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LVEF &#8805;50&#37; &#40;n&#61;190&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LVEF &#60;50&#37; &#40;n&#61;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Source of referral &#37; &#40;n&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Primary care&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;8 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Emergency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;7 &#40;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;6 &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;6 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;3 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;2 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;6 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Internal medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;9 &#40;206&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73 &#40;138&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#46;7 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;0 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;7 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Source of patient referrals&#46;</p>"
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">ACE&#58; angiotensin-converting enzyme&#59; ARBs&#58; angiotensin receptor blockers&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Overall &#40;n&#61;301&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LVEF &#8805;50&#37; &#40;n&#61;190&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LVEF &#60;50&#37; &#40;n&#61;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Treatment&#44; &#37; &#40;n&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ACE inhibitors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;1 &#40;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;9 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;2 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;910&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ARBs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#46;6 &#40;122&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#46;1 &#40;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;8 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;256&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Spironolactone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;8 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;8 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;3 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;570&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Beta-blockers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#46;5 &#40;139&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;2 &#40;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;2 &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Pharmacological treatment according to left ventricular ejection fraction&#46;</p>"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0155" class="elsevierStyleSimplePara elsevierViewall">LVEF&#58; left ventricular ejection fraction&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Overall &#40;n&#61;301&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LVEF &#8805;50&#37; &#40;n&#61;190&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LVEF &#60;50&#37; &#40;n&#61;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Follow-up&#44; months &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;11&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;5 &#40;12&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;11&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;946&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">End of observational period&#44; &#37; &#40;n&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;5 &#40;113&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;9 &#40;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#46;4 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;465&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Discharge to cardiology clinic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;3 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;7 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;1 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;465&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Discharge to health care unit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;3 &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;4 &#40;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;9 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;465&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;0 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;2 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;465&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lost to follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;9 &#40;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;4 &#40;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;9 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;465&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Intervention&#44; &#37; &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#46;0 &#40;262&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#46;9 &#40;167&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;274&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Mortality&#44; &#37; &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;8 &#40;144&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#46;1 &#40;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;7 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;257&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Follow-up and mortality&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:44 [
            0 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of heart failure in Spain over the last 20 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46; Sayago-Silva"
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