American Registry of Ambulatory or acutely decompensated heart failure (AMERICCAASS Registry): First 1000 patients.

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.

Caracterización clínica de insuficiencia cardiaca en pacientes internados en el Instituto Nacional de Cardiología, Paraguay

Introducción: la insuficiencia cardiaca es una de las enfermedades cardiovasculares más prevalentes en la población general y el estadio obligatorio de todas las patologías cardiovasculares, la cual irá en aumento a medida que crezca la expectativa de vida de la población. Objetivo: determinar las características de pacientes con insuficiencia cardiaca internados en el Instituto Nacional de Cardiología de Paraguay, durante un periodo de tres meses del año 2020. Metodología: estudio descriptivo de una muestra de 140 pacientes con diagnóstico de insuficiencia cardiaca. Los criterios para establecer este diagnóstico fueron clínicos y/o ecocardiográficos. Resultados: la media de edad fue 66 años, 57% del sexo masculino. El 88% de los pacientes presentaron hipertensión arterial. La etiología más frecuente fue la isquémica (26%), la mayoría consultó en clase funcional III y presentó fracción de eyección reducida, calculándose una prevalencia institucional 7,2%. Conclusión: el perfil del paciente con diagnóstico de insuficiencia cardiaca que consulta en este servicio es de un hombre de aproximadamente 66 años en clase funcional III, con fracción de eyección reducida y de etiología isquémica, cuyas patologías de base son hipertensión arterial y diabetes mellitus.

Introduction: Heart failure is one of the most prevalent cardiovascular diseases in the general population and the mandatory stage of all cardiovascular pathologies, which will increase as the life expectancy of the population grows. Objective: To determine the characteristics of patients with heart failure hospitalized at the National Institute of Cardiology of Paraguay, during a period of three months of the year 2020. Methodology: Descriptive study of a sample of 140 patients diagnosed with heart failure. The criteria to establish this diagnosis were clinical and/or echocardiographic. Results: The average age was 66 years, 57% male, and 88% of the patients had arterial hypertension. The most frequent etiology was ischemic (26%), the majority consulted in functional class III and presented reduced ejection fraction, calculating an institutional prevalence of 7.2%. Conclusion: The profile of the patient with a diagnosis of heart failure who consults in this service is that of a man of approximately 66 years old, in functional class III, with reduced ejection fraction and ischemic etiology, whose underlying pathologies are arterial hypertension and diabetes mellitus.

Evaluación de resultados en una serie de pacientes con trasplante cardiaco: experiencia en el Instituto Nacional de Cardiología

Exponemos la experiencia del Instituto Nacional de Cardiología de una serie de casos de pacientes sometidos a trasplante cardiaco entre mayo de 2016 y junio 2022. Se realizaron 14 trasplantes, 13 fueron del sexo masculino. La edad osciló entre 19 y 62 años. Las etiologías fueron cardiopatías de tipo idiopática en 57% y valvular en 21%. El 50% se trasplantó en INTERMACS 4 (Interagency Registry for Mechanically Assisted Circulatory Support), 21% INTERMACS 3 y solo 28% en INTERMACS 2. Tres pacientes se trasplantaron con asistencia circulatoria tipo membrana circulación extracorpórea. Las complicaciones más frecuentes fueron las infecciosas. La mortalidad hospitalaria fue 35,7%. Hubo un fallecido en el seguimiento tras 5 años de trasplante.

We present the experience of the National Institute of Cardiology of a series of cases of patients undergoing heart transplantation between May 2016 and June 2022. Fourteen transplants were performed, 13 of the patients were male. The age ranged between 19 and 62 years. The etiologies were idiopathic heart disease in 57% and valvular heart disease in 21%. Fifty percent was transplanted in INTERMACS 4 (Interagency Registry for Mechanically Assisted Circulatory Support), 21% in INTERMACS 3 and only 28% in INTERMACS 2. Three patients were transplanted with membrane type extracorporeal circulation circulatory support. The most frequent complications were infectious. Hospital mortality was 35.7%. There was one patient who died during follow-up after 5 years of transplantation.