RESUMO
AIMS: Heart failure (HF) is a highly prevalent and progressive condition associated with significant morbidity and mortality rates. Acute decompensated HF precipitates millions of hospitalizations each year. Despite therapeutic advances, the overall prognosis of HF is poor. The varying clinical courses and outcomes of patients with this disease may be due to region-specific gaps and since most HF studies are conducted in developed countries, the participation of Latin American and Caribbean countries is low. Considering this, the American Registry of Ambulatory and Acute Decompensated Heart Failure (AMERICCAASS) aims to characterize the population with ambulatory and acute decompensated HF in the American continent and to determine rehospitalization and survival outcomes during the 12 months of follow-up. METHODS AND RESULTS: AMERICCAASS Registry is an observational, prospective, and hospital-based registry recruiting patients with ambulatory or acute decompensated HF. The registry plans to include between two and four institutions per country from at least 20 countries in the Americas, and at least 60 patients recruited from each participant institution regardless of their ambulatory or acutely decompensated condition. Ambulatory patients with confirmed HF diagnosis or inpatients presenting with acute decompensated HF will be included. Follow-up will be performed at 12 months in ambulatory patients or 1, 6, and 12 months after hospital discharge in acutely decompensated HF patients. This ongoing study began on 1 April 2022, with recruitment scheduled to end on 30 November 2023, and follow-up on 31 January 2025. Ethics approval was obtained from the Biomedical Research Ethics Committee of Fundación Valle del Lili. Data collected in the AMERICCAASS registry is being stored on the electronic platform REDCap (Research Electronic Data Capture), which allows different forms for patient groups to enable unbiased analyses. For quantitative variables comparison, we will use the Student's t-test or non-parametric tests accordingly. Categorical variables will be presented as proportions, and groups will be compared with Fisher's exact test. The significance level will be <0.05 for comparisons. Readmissions and post-discharge mortality will be calculated as proportions at 1, 6, and 12 months, with a survival analysis by conditional probability and the Kaplan-Meier method. CONCLUSIONS: AMERICCAASS Registry is intended to be the most important registry of the continent for obtaining important information about demographics, aetiology, co-morbidities, and treatment received, either ambulatory or hospitalized. This registry may contribute to the optimization of national and regional evidence and public policies for the diagnosis and treatment of HF disease.
RESUMO
BACKGROUND: About 80% of cardiovascular diseases (including heart failure [HF]) occur in low-income and developing countries. However, most clinical trials are conducted in developed countries. HYPOTHESIS: The American Registry of Ambulatory or Acutely Decompensated Heart Failure (AMERICCAASS) aims to describe the sociodemographic characteristics of HF, comorbidities, clinical presentation, and pharmacological management of patients with ambulatory or acutely decompensated HF in America. METHODOLOGY: Descriptive, observational, prospective, and multicenter registry, which includes patients >18 years with HF in an outpatient or hospital setting. Collected information is stored in the REDCap electronic platform. Quantitative variables are defined according to the normality of the variable using the Shapiro-Wilk test. RESULTS: This analysis includes data from the first 1000 patients recruited. 63.5% were men, the median age of 66 years (interquartile range 56.7-75.4), and 77.6% of the patients were older than 55 years old. The percentage of use of the four pharmacological pillars at the time of recruitment was 70.7% for beta-blockers (BB), 77.4% for angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB II)/angiotensin receptor-neprilysin inhibitor (ARNI), 56.8% for mineralocorticoid receptor antagonists (MRA), and 30.7% for sodium-glucose cotransporter type-2 inhibitors (SGLT2i). The main cause of decompensation in hospitalized patients was HF progression (64.4%), and the predominant hemodynamic profile was wet-warm (68.3%). CONCLUSIONS: AMERICCAASS is the first continental registry to include hospitalized or outpatient patients with HF. Regarding optimal medical therapy, approximately a quarter of the patients still need to receive BB and ACEI/ARB/ARNI, less than half do not receive MRA, and more than two-thirds do not receive SGLT2i.
Assuntos
Inibidores da Enzima Conversora de Angiotensina , Insuficiência Cardíaca , Masculino , Humanos , Estados Unidos/epidemiologia , Idoso , Pessoa de Meia-Idade , Feminino , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Estudos Prospectivos , Volume Sistólico , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/epidemiologia , Sistema de Registros , Antagonistas Adrenérgicos beta/uso terapêutico , Antagonistas de Receptores de Mineralocorticoides/uso terapêuticoRESUMO
Background: Nurse-led multidisciplinary heart failure clinics (MDHFCs) play an important role in patient care in developed countries, due to their proven benefits relating to mortality, hospitalization, and quality of life. However, evidence is limited regarding the role of MDHFCs in a limited-resource setting. Methods: Patients with heart failure (HF) with reduced ejection fraction (n = 89) were enrolled in a prospective, longitudinal cohort, from January 2018 to January 2019. The following endpoints were collected at baseline and after 6 months of follow-up: (i) quality of life, measured using the Minnesota Living with Heart Failure Questionnaire; (ii) medication adherence using the Morisky Medication Adherence Scale, 8-item; (iii) titration of HF medications; (iv) self-care behavior using the European Heart Failure Self-care Behavior Scale; and (v) mortality and hospitalizations up to 12 months after. Results: The questionnaire score was reduced from 66.5 (interquartile range [IQR], 46-86) at baseline to 26 (IQR, 13-45) at 6 months (P < 0.001). New York Heart Association (NYHA) functional class improved at 6 months (NYHA I: 41.9%; NYHA II: 39.5%; NYHA III: 17.2%), compared to baseline (NYHA I: 20%; NYHA II: 49%; NYHA III: 31%; P < 0.001). Medication adherence using the 8-item Morisky Medication Adherence Scale improved the score from 6 (IQR, 4-7) at baseline to 7 (IQR, 6.25-8; P = 0.001) at 6 months. Uptitration of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (25% vs 18% at target dose) and beta-blockers (25% vs 11% at target dose) was documented. After 6 months of follow-up, the European Heart Failure Self-care Behavior Scale was applied, showing a score of 18.5 (IQR, 15-22). The mortality reported at 12 months of follow-up was 9.7%, and the incidence of hospitalization was 44%. Conclusion: An MDHFC is a feasible strategy to manage an HF clinic in a low-resource setting.
Contexte: Les cliniques multidisciplinaires d'insuffisance cardiaque dirigées par du personnel infirmier jouent un rôle important dans les soins aux patients dans les pays développés en raison de leurs bienfaits démontrés en matière de mortalité, d'hospitalisation, et de qualité de vie. Les preuves quant au rôle de ce type de cliniques dans un contexte de pénurie de ressources sont toutefois limitées. Méthodologie: Des patients atteints d'insuffisance cardiaque (IC) présentant une fraction d'éjection réduite (n = 89) ont été inscrits à une étude de cohortes prospective et longitudinale allant de janvier 2018 à janvier 2019. Les critères d'évaluation suivants ont été mesurés à l'inscription et après six mois de suivi : i) qualité de vie, mesurée par le questionnaire Minnesota Living with Heart Failure Questionnaire; ii) adhésion au traitement médicamenteux, mesuré selon l'échelle en huit points Morisky Medication Adherence Scale; iii) modification de la dose de médicaments contre l'IC; iv) comportements d'autosoins, mesurés selon l'échelle European Heart Failure Self-care Behavior Scale; et v) taux de mortalité et d'hospitalisation jusqu'à 12 mois. Résultats: Le score au questionnaire a diminué pour passer de 66,5 (écart interquartile [EI] : 46 à 86) au départ à 26 (EI : 13 à 45) à six mois (p < 0,001). La catégorie fonctionnelle de la New York Heart Association (NYHA) s'est améliorée à six mois (NYHA I : 41,9 %; NYHA II : 39,5 %; NYHA III : 17,2 %), comparativement au départ (NYHA I : 20 %; NYHA II : 49 %; NYHA III : 31 %; p < 0,001). Le score de l'adhésion au traitement médicamenteux mesuré par l'échelle en huit points Morisky Medication Adherence Scale s'est amélioré, passant de 6 (EI : 4 à 7) au départ à 7 (EI : 6,25 à 8; p = 0,001) à six mois. On a noté une augmentation de la dose d'inhibiteurs de l'enzyme de conversion de l'angiotensine ou de bloqueurs des récepteurs de l'angiotensine (25 % vs 18 % à la dose cible) et de bêtabloquants (25 % vs 11 % à la dose cible). Après six mois de suivi, l'échelle European Heart Failure Self-care Behavior Scale a été appliquée, ce qui a donné un score de 18,5 (EI : 15 à 22). Le taux de mortalité rapporté à 12 mois de suivi était de 9,7 %, et le taux d'hospitalisation était de 44 %. Conclusion: Une clinique multidisciplinaire d'insuffisance cardiaque dirigée par du personnel infirmier est une stratégie réaliste pour gérer une clinique d'IC dans un contexte de pénurie de ressources.
RESUMO
RESUMEN El presente trabajo es el resultado de una iniciativa para analizar, resumir y mostrar la evidencia científica más reciente sobre el tema de la hipertensión y la implementación de las mejores terapéuticas disponibles. Este documento fue creado con la colaboración conjunta de médicos especialistas para dar una perspectiva local a la gestión basada en la mejor evi- dencia científica y en el contexto de la región de Centroamérica y el Caribe. Este artículo cuenta con el respaldo científico y académico de la Sociedad Centroamericana y del Caribe de Cardiología y es el primero de su tipo en abordar el problema y tema de la hipertensión. Se desarrolló a partir de una revisión detallada de la evidencia científica utilizando los principales buscadores médicos, seleccionando los estudios pivotales y poblacionales con mayor nivel de evidencia disponible. La in- tención es brindar información sencilla, con recomendaciones fáciles de implementar en el manejo diario de los pacientes con hipertensión arterial. Este documento contó con el apoyo logístico del Laboratorio Servier, tanto con los autores como en su edición; sin embargo, la información clínica presentada no estuvo condicionada por el laboratorio. Este material es responsabilidad de los autores.
ABSTRACT Antihypertensive therapy recommendations: the importance of combinations Endorsed by the Central American and Caribbean Society of Cardiology The present work is the result of an initiative to analyze, summarize, and show the latest scientific evidence on the subject of hypertension and the implementation of the best available therapeutics. This document was created with the joint collaboration of medical specialists to give a local perspective to the management based on the best scientific evidence and in the context of the Central American and Caribbean region. This paper has the scientific and academic support of the Central American and Caribbean Society of Cardiology and is the first of its kind to address the problem and topic of hypertension. It was developed from a detailed review of the scientific evidence using the main medical search engines, selecting the pivotal and population-based studies with the highest level of evidence available. The intention is to provide simple information, with easy-to-implement recommendations to implement in the daily management of patients with arterial hypertension. This document had the logistic support of Servier Laboratory, both with the authors as well as its editing; however, the clinical information presented was not conditioned by the laboratory. This material is the responsibility of the authors.