The First Brazilian Cardiovascular Registry of Atrial Fibrillation: Primary Results of the RECALL Study.

BACKGROUND: It is estimated that atrial fibrillation (AF) affects approximately 1.5 million people in Brazil; however, epidemiological data are limited. We sought to evaluate the characteristics, treatment patterns, and clinical outcomes in patients with AF in Brazil by creating the first nationwide prospective registry. METHODS: RECALL was a multicenter, prospective registry that included and followed for 1 year 4,585 patients with AF at 89 sites across Brazil from April 2012 to August 2019. Patient characteristics, concomitant medication use, and clinical outcomes were analyzed using descriptive statistics and multivariable models. RESULTS: Of 4,585 patients enrolled, the median age was 70 (61, 78) years, 46% were women, and 53.8% had permanent AF. Only 4.4% of patients had a history of previous AF ablation and 25.2% had a previous cardioversion. The mean (SD) CHA2DS2-VASc score was 3.2 (1.6); median HAS-BLED score was 2 (2, 3). At baseline, 22% were not on anticoagulants. Of those taking anticoagulants, 62.6% were taking vitamin K antagonists and 37.4% were taking direct oral anticoagulants. The primary reasons for not using an oral anticoagulant were physician judgment (24.6%) and difficulty in controlling (14.7%) or performing (9.9%) INR. Mean (SD) TTR for the study period was 49.5% (27.5). During follow-up, the use of anticoagulants and INR in the therapeutic range increased to 87.1% and 59.1%, respectively. The rates/100 patient-years of death, hospitalization due to AF, AF ablation, cardioversion, stroke, systemic embolism, and major bleeding were 5.76 (5.12-6.47), 15.8 (14.6-17.0), 5.0 (4.4-5.7), 1.8 (1.4-2.2), 2.77 (2.32-3.32), 1.01 (0.75-1.36), and 2.21 (1.81-2.70). Older age, permanent AF, New York Heart Association class III/IV, chronic kidney disease, peripheral arterial disease, stroke, chronic obstructive pulmonary disease, and dementia were independently associated with increased mortality while the use of anticoagulant was associated with lower risk of death. CONCLUSIONS: RECALL represents the largest prospective registry of patients with AF in Latin America. Our findings highlight important gaps in treatment, which can inform clinical practice and guide future interventions to improve the care of these patients.

Favorable effects of the optimized drug treatment of heart failure on ventricular arrhythmias.

BACKGROUND: Ventricular arrhythmic events have a strong impact on the mortality of patients with heart failure. The benefits of the optimized drug treatment of heart failure in reducing ventricular arrhythmia have not been well documented yet. OBJECTIVE: To analyze the effects of the optimized drug treatment of heart failure on ventricular arrhythmia. METHODS: This is a clinical study with a non-randomized design of 85 consecutive (open cohort) non-selected patients, with a mean age of 63.8+/-12.2 years; 42 were males and 43 were females. All patients had a diagnosis of heart failure (HF), NYHA Functional Class II to IV, EF

Efeito favorável da terapia farmacológica otimizada da insuficiência cardíaca sobre as arritmias ventriculares / Favorable effects of the optimized drug treatment of heart failure on ventricular arrhythmias

FUNDAMENTO: Os eventos arrítmicos ventriculares têm forte impacto na mortalidade dos pacientes com insuficiência cardíaca. O benefício do tratamento farmacológico otimizado da insuficiência cardíaca na redução da arritmia ventricular não foi ainda muito bem documentado. OBJETIVO: Análise dos efeitos do tratamento farmacológico otimizado da insuficiência cardíaca sobre a arritmia ventricular. MÉTODOS: Estudo clínico com desenho não aleatorizado, envolvendo 85 pacientes consecutivos (coorte aberta), não selecionados, idade média de 63,8±12,2 anos, 42 homens, 43 mulheres, com diagnóstico de insuficiência cardíaca, classes funcionais II a IV (NYHA - New York Heart Association), FE (fração de ejeção) < 0,40, que após otimização do tratamento foram acompanhados de janeiro de 2002 a maio de 2004, quanto ao comportamento da arritmia ventricular, à admissão e ao término do estudo. RESULTADOS: No início do estudo 60 por cento dos pacientes apresentaram mais de 1000 extra-sístoles ventriculares/24h, 100 por cento pares e 100 por cento taquicardia ventricular não sustentada (TVNS). Num seguimento que variou de 8 a 27 meses (20,0 + 4,8 meses) observou-se redução significativa do número total de extra-sístoles ventriculares/24h, do número de pares e do número de episódios de taquicardia ventricular não sustentada (p<0,05). Observou-se também melhora da classe funcional e do desempenho ao teste de caminhada de seis minutos. Em relação à fase anterior à inclusão no estudo observou-se diminuição das internações hospitalares (4,8 hospitalizações/paciente/ano e ao término do estudo 2,7 hospitalizações/paciente/ano) (p<0,005). CONCLUSÃO: O tratamento otimizado da insuficiência cardíaca diminuiu a ocorrência de arritmias ventriculares. A melhora da classe funcional, do desempenho físico e do número de hospitalizações podem ser atribuídas ao tratamento otimizado.

BACKGROUND: Ventricular arrhythmic events have a strong impact on the mortality of patients with heart failure. The benefits of the optimized drug treatment of heart failure in reducing ventricular arrhythmia have not been well documented yet. OBJECTIVE: To analyze the effects of the optimized drug treatment of heart failure on ventricular arrhythmia. METHODS: This is a clinical study with a non-randomized design of 85 consecutive (open cohort) non-selected patients, with a mean age of 63.8±12.2 years; 42 were males and 43 were females. All patients had a diagnosis of heart failure (HF), NYHA Functional Class II to IV, EF < 0.40 and, after treatment optimization, they were followed from January 2002 to May 2004, regarding the ventricular arrhythmia behavior, at admission and at the end of the study. RESULTS: At the start of the study, 60 percent of patients presented more than 1,000 ventricular extrasystoles in 24 hours, 100 percent pairs and 100 percent nonsustained ventricular tachycardia (NSVT). During a follow-up period of 8 to 27 months (20.0 + 4.8 months) a significant decrease in the total number of ventricular extrasystoles/24 hrs, number of pairs and number of NSVT episodes was observed (p<0.05). The improvement in functional class and performance at the six-minute walk test was also observed. A decrease in hospital admissions was also observed in relation to the period prior to the study inclusion (4.8 hospital admissions/patient/year and at the end of the study, 2.7 hospital admissions/patient/year) (p<0.005). CONCLUSION: The optimized treatment of HF decreased the incidence of ventricular arrhythmias. The improvement in the functional class, physical performance and the decreased number of hospitalizations can be attributed to the optimized treatment of HF.

Eficácia e tolerabilidade da associaçäo bisoprolol hidroclorotiazida na hipertensäo arterial / Efficacy and tolerability of the bisoprolol/hydrochlorothiazide combination in the treatment of arterial hypertension

Objetivo - Estudo multicêntrico, aberto e não comparativo, para avaliar a eficácia e a tolerabilidade de dois agentes anti-hipertensivos combinados em doses baixas: o beta-bloqueador cardiosseletivo bisoprolol (2,5 e 5,0mg) com 6,25mg de hidrocloratizada. Métodos - Cento e seis pacientes com hipertensão arterial nos estágios I e II (leve a moderada) receberam a combinação bisoprolol/hidrocloratizada, em uma única dose diária, e foram submetidos a uma avaliação da pressão arterial sistólica (PAS) e pressão arterial diastólica (PAD), durante 8 semanas. Resultados - A combinação bisoprolol/hidrocloratiazida reduziu significativamente os valores médios iniciais da PAS (157,4mmHg para 1373,3mmHg) e da PAD (98,8mmHg para 87,4mmHg). Ao final do estudo, 61 por cento haviam normalizado a PA (<90mmHg) e 22,9 por cento deles foram responsivos ao tratamento, resultando em elevada taxa de resposta terapêutica (normalizados + responsivos) - total de 83,9 por cento dos casos. Eventos adversos foram descritos em 18,9 por cento dos pacientes, sendo os mais freqüentes: tontura e cefaléia. Não se observaram alterações clinicamente significativas nos níveis plasmáticos de glicose, potássio, ácido útico e perfil lipídico. Conclusão - A combinação bisoprolol/hidroclorotiazida em baixas doses pode ser considerada uma alternativa racional, eficaz e bem tolerada para o tratamento inicial da hipertensão arterial leve ou moderada.