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1.
J Card Fail ; 2023 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-37648061

RESUMEN

BACKGROUND: Heart failure (HF), a common cause of hospitalization, is associated with poor short-term clinical outcomes. Little is known about the long-term prognoses of patients with HF in Latin America. METHODS: BREATHE was the first nationwide prospective observational study in Brazil that included patients hospitalized due to acute heart failure (HF). Patients were included during 2 time periods: February 2011-December 2012 and June 2016-July 2018 SUGGESTION FOR REPHRASING: In-hospital management, 12-month clinical outcomes and adherence to evidence-based therapies were evaluated. RESULTS: A total of 3013 patients were enrolled at 71 centers in Brazil. At hospital admission, 83.8% had clear signs of pulmonary congestion. The main cause of decompensation was poor adherence to HF medications (27.8%). Among patients with reduced ejection fraction, concomitant use of beta-blockers, renin-angiotensin-aldosterone inhibitors and spironolactone decreased from 44.5% at hospital discharge to 35.2% at 3 months. The cumulative incidence of mortality at 12 months was 27.7%, with 24.3% readmission at 90 days and 44.4% at 12 months. CONCLUSIONS: In this large national prospective registry of patients hospitalized with acute HF, rates of mortality and readmission were higher than those reported globally. Poor adherence to evidence-based therapies was common at hospital discharge and at 12 months of follow-up.

2.
JAMA ; 319(13): 1331-1340, 2018 04 03.
Artículo en Inglés | MEDLINE | ID: mdl-29525821

RESUMEN

Importance: The effects of loading doses of statins on clinical outcomes in patients with acute coronary syndrome (ACS) and planned invasive management remain uncertain. Objective: To determine if periprocedural loading doses of atorvastatin decrease 30-day major adverse cardiovascular events (MACE) in patients with ACS and planned invasive management. Design, Setting, and Participants: Multicenter, double-blind, placebo-controlled, randomized clinical trial conducted at 53 sites in Brazil among 4191 patients with ACS evaluated with coronary angiography to proceed with a percutaneous coronary intervention (PCI) if anatomically feasible. Enrollment occurred between April 18, 2012, and October 6, 2017. Final follow-up for 30-day outcomes was on November 6, 2017. Interventions: Patients were randomized to receive 2 loading doses of 80 mg of atorvastatin (n = 2087) or matching placebo (n = 2104) before and 24 hours after a planned PCI. All patients received 40 mg of atorvastatin for 30 days starting 24 hours after the second dose of study medication. Main Outcomes and Measures: The primary outcome was MACE, defined as a composite of all-cause mortality, myocardial infarction, stroke, and unplanned coronary revascularization through 30 days. Results: Among the 4191 patients (mean age, 61.8 [SD, 11.5] years; 1085 women [25.9%]) enrolled, 4163 (99.3%) completed 30-day follow-up. A total of 2710 (64.7%) underwent PCI, 333 (8%) underwent coronary artery bypass graft surgery, and 1144 (27.3%) had exclusively medical management. At 30 days, 130 patients in the atorvastatin group (6.2%) and 149 in the placebo group (7.1%) had a MACE (absolute difference, 0.85% [95% CI, -0.70% to 2.41%]; hazard ratio, 0.88; 95% CI, 0.69-1.11; P = .27). No cases of hepatic failure were reported; 3 cases of rhabdomyolysis were reported in the placebo group (0.1%) and 0 in the atorvastatin group. Conclusions and Relevance: Among patients with ACS and planned invasive management with PCI, periprocedural loading doses of atorvastatin did not reduce the rate of MACE at 30 days. These findings do not support the routine use of loading doses of atorvastatin among unselected patients with ACS and intended invasive management. Trial Registration: clinicaltrials.gov Identifier: NCT01448642.


Asunto(s)
Síndrome Coronario Agudo/tratamiento farmacológico , Atorvastatina/administración & dosificación , Enfermedades Cardiovasculares/prevención & control , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Intervención Coronaria Percutánea , Síndrome Coronario Agudo/terapia , Anciano , Atorvastatina/efectos adversos , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/mortalidad , Método Doble Ciego , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Infarto del Miocardio con Elevación del ST/tratamiento farmacológico , Infarto del Miocardio con Elevación del ST/terapia
3.
Rev Bras Ter Intensiva ; 34(4): 418-425, 2022.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-36888821

RESUMEN

OBJECTIVE: To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. METHODS: We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. RESULTS: The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. CONCLUSION: The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.


OBJETIVO: Descrever o IMPACTO-MR, um estudo brasileiro de plataforma nacional em unidades de terapia intensiva focado no impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. MÉTODOS: Descrevemos a plataforma IMPACTO-MR, seu desenvolvimento, critérios para seleção das unidades de terapia intensiva, caracterização da coleta de dados, objetivos e projetos de pesquisa futuros a serem realizados na plataforma. RESULTADOS: Os dados principais foram coletados por meio do Epimed Monitor System® e consistiram em dados demográficos, dados de comorbidades, estado funcional, escores clínicos, diagnóstico de internação e diagnósticos secundários, dados laboratoriais, clínicos e microbiológicos e suporte de órgãos durante a internação na unidade de terapia intensiva, entre outros. De outubro de 2019 a dezembro de 2020, 33.983 pacientes de 51 unidades de terapia intensiva foram incluídos no banco de dados principal. CONCLUSÃO: A plataforma IMPACTO-MR é um banco de dados clínico brasileiro de unidades de terapia intensiva focado na pesquisa do impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Essa plataforma fornece dados para o desenvolvimento e pesquisa de unidades de terapia intensiva individuais e ensaios clínicos observacionais e prospectivos multicêntricos.


Asunto(s)
Infección Hospitalaria , Unidades de Cuidados Intensivos , Humanos , Estudios Prospectivos , Brasil , Infección Hospitalaria/epidemiología , Farmacorresistencia Bacteriana Múltiple
4.
Tomazini, Bruno M; Nassar Jr, Antonio Paulo; Lisboa, Thiago Costa; Azevedo, Luciano César Pontes de; Veiga, Viviane Cordeiro; Catarino, Daniela Ghidetti Mangas; Fogazzi, Debora Vacaro; Arns, Beatriz; Piastrelli, Filipe Teixeira; Dietrich, Camila; Negrelli, Karina Leal; Jesuíno, Isabella de Andrade; Reis, Luiz Fernando Lima; Mattos, Renata Rodrigues de; Pinheiro, Carla Cristina Gomes; Luz, Mariane Nascimento; Spadoni, Clayse Carla da Silva; Moro, Elisângela Emilene; Bueno, Flávia Regina; Sampaio, Camila Santana Justo Cintra; Silva, Débora Patrício; Baldassare, Franca Pellison; Silva, Ana Cecilia Alcantara; Veiga, Thabata; Barbante, Leticia; Lambauer, Marianne; Campos, Viviane Bezerra; Santos, Elton; Santos, Renato Hideo Nakawaga; Laranjeiras, Ligia Nasi; Valeis, Nanci; Santucci, Eliana; Miranda, Tamiris Abait; Patrocínio, Ana Cristina Lagoeiro do; Carvalho, Andréa de; Sousa, Eduvirgens Maria Couto de; Sousa, Ancelmo Honorato Ferraz de; Malheiro, Daniel Tavares; Bezerra, Isabella Lott; Rodrigues, Mirian Batista; Malicia, Julliana Chicuta; Silva, Sabrina Souza da; Gimenes, Bruna dos Passos; Sesin, Guilhermo Prates; Zavascki, Alexandre Prehn; Sganzerla, Daniel; Medeiros, Gregory Saraiva; Santos, Rosa da Rosa Minho dos; Silva, Fernanda Kelly Romeiro; Cheno, Maysa Yukari; Abrahão, Carolinne Ferreira; Oliveira Junior, Haliton Alves de; Rocha, Leonardo Lima; Nunes Neto, Pedro Aniceto; Pereira, Valéria Chagas; Paciência, Luis Eduardo Miranda; Bueno, Elaine Silva; Caser, Eliana Bernadete; Ribeiro, Larissa Zuqui; Fernandes, Caio Cesar Ferreira; Garcia, Juliana Mazzei; Silva, Vanildes de Fátima Fernandes; Santos, Alisson Junior dos; Machado, Flávia Ribeiro; Souza, Maria Aparecida de; Ferronato, Bianca Ramos; Urbano, Hugo Corrêa de Andrade; Moreira, Danielle Conceição Aparecida; Souza-Dantas, Vicente Cés de; Duarte, Diego Meireles; Coelho, Juliana; Figueiredo, Rodrigo Cruvinel; Foreque, Fernanda; Romano, Thiago Gomes; Cubos, Daniel; Spirale, Vladimir Miguel; Nogueira, Roberta Schiavon; Maia, Israel Silva; Zandonai, Cassio Luis; Lovato, Wilson José; Cerantola, Rodrigo Barbosa; Toledo, Tatiana Gozzi Pancev; Tomba, Pablo Oscar; Almeida, Joyce Ramos de; Sanches, Luciana Coelho; Pierini, Leticia; Cunha, Mariana; Sousa, Michelle Tereza; Azevedo, Bruna; Dal-Pizzol, Felipe; Damasio, Danusa de Castro; Bainy, Marina Peres; Beduhn, Dagoberta Alves Vieira; Jatobá, Joana DArc Vila Nova; Moura, Maria Tereza Farias de; Rego, Leila Rezegue de Moraes; Silva, Adria Vanessa da; Oliveira, Luana Pontes; Sodré Filho, Eliene Sá; Santos, Silvana Soares dos; Neves, Itallo de Lima; Leão, Vanessa Cristina de Aquino; Paes, João Lucidio Lobato; Silva, Marielle Cristina Mendes; Oliveira, Cláudio Dornas de; Santiago, Raquel Caldeira Brant; Paranhos, Jorge Luiz da Rocha; Wiermann, Iany Grinezia da Silva; Pedroso, Durval Ferreira Fonseca; Sawada, Priscilla Yoshiko; Prestes, Rejane Martins; Nascimento, Glícia Cardoso; Grion, Cintia Magalhães Carvalho; Carrilho, Claudia Maria Dantas de Maio; Dantas, Roberta Lacerda Almeida de Miranda; Silva, Eliane Pereira; Silva, Antônio Carlos da; Oliveira, Sheila Mara Bezerra de; Golin, Nicole Alberti; Tregnago, Rogerio; Lima, Valéria Paes; Silva, Kamilla Grasielle Nunes da; Boschi, Emerson; Buffon, Viviane; Machado, André SantAna; Capeletti, Leticia; Foernges, Rafael Botelho; Carvalho, Andréia Schubert de; Oliveira Junior, Lúcio Couto de; Oliveira, Daniela Cunha de; Silva, Everton Macêdo; Ribeiro, Julival; Pereira, Francielle Constantino; Salgado, Fernanda Borges; Deutschendorf, Caroline; Silva, Cristofer Farias da; Gobatto, Andre Luiz Nunes; Oliveira, Carolaine Bomfim de; Dracoulakis, Marianna Deway Andrade; Alvaia, Natália Oliveira Santos; Souza, Roberta Machado de; Araújo, Larissa Liz Cardoso de; Melo, Rodrigo Morel Vieira de; Passos, Luiz Carlos Santana; Vidal, Claudia Fernanda de Lacerda; Rodrigues, Fernanda Lopes de Albuquerque; Kurtz, Pedro; Shinotsuka, Cássia Righy; Tavares, Maria Brandão; Santana, Igor das Virgens; Gavinho, Luciana Macedo da Silva; Nascimento, Alaís Brito; Pereira, Adriano J; Cavalcanti, Alexandre Biasi.
Rev. bras. ter. intensiva ; 34(4): 418-425, out.-dez. 2022. tab, graf
Artículo en Portugués | LILACS-Express | LILACS | ID: biblio-1423667

RESUMEN

RESUMO Objetivo: Descrever o IMPACTO-MR, um estudo brasileiro de plataforma nacional em unidades de terapia intensiva focado no impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Métodos: Descrevemos a plataforma IMPACTO-MR, seu desenvolvimento, critérios para seleção das unidades de terapia intensiva, caracterização da coleta de dados, objetivos e projetos de pesquisa futuros a serem realizados na plataforma. Resultados: Os dados principais foram coletados por meio do Epimed Monitor System® e consistiram em dados demográficos, dados de comorbidades, estado funcional, escores clínicos, diagnóstico de internação e diagnósticos secundários, dados laboratoriais, clínicos e microbiológicos e suporte de órgãos durante a internação na unidade de terapia intensiva, entre outros. De outubro de 2019 a dezembro de 2020, 33.983 pacientes de 51 unidades de terapia intensiva foram incluídos no banco de dados principal. Conclusão: A plataforma IMPACTO-MR é um banco de dados clínico brasileiro de unidades de terapia intensiva focado na pesquisa do impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Essa plataforma fornece dados para o desenvolvimento e pesquisa de unidades de terapia intensiva individuais e ensaios clínicos observacionais e prospectivos multicêntricos.


ABSTRACT Objective: To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. Methods: We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. Results: The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. Conclusion: The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.

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