Adherence to treatment guidelines in Ambulatory Heart Failure Patients with Reduced Ejection Fraction in a Latin-American Country: Observational Study of the Colombian Heart Failure Registry (RECOLFACA).

INTRODUCTION: Although several guidelines recommend that patients with heart failure with reduced ejection fraction (HFrEF) be treated with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) or angiotensin receptor - neprilysin inhibitors (ARNI), beta-blockers, mineralocorticoid receptor antagonists (MRA), and sodium-glucose cocotransporter-2 inhibitor (SGLT2i), there are still several gaps in their prescription and dosage in Colombia. This study aims to describe the use patterns of HFrEF treatments in the Colombian Heart Failure Registry (RECOLFACA). METHODS: Patients with HFrEF enrolled in RECOLFACA during 2017-2019 were included. Heart Failure (HF) medications prescription and daily dose were assessed using absolute numbers and proportions. Therapeutic schemes of patients treated by internal medicine specialists were compared with those treated by cardiologists. RESULTS: Out of 2528 patients in the registry, 1384 (54.7%) had HFrEF. Among those individuals, 88.9% were prescribed beta-blockers, 72.3% with ACEI/ARBs, 67.9% with MRAs, and 13.1% with ARNIs. Moreover, less than a third of the total patients reached the target doses recommended by the European HF guidelines. No significant differences in the therapeutic schemes or target doses were observed between patients treated by internal medicine specialists or cardiologists. CONCLUSION: Prescription rates and target dose achievement is sub-optimal in Colombia. Nevertheless, RECOLFACA had one of the highest prescription rates of beta-blockers and MRAs compared to some of the most recent HF registries. However, ARNIs remain underprescribed. Continuous registry updates can improve the identification of patients suitable for ARNI and SGLT2i therapy to promote their use in clinical practice.

Clinical Profile and Prognosis of a Real-World Cohort of Patients With Moderate or Severe Cancer Therapy-Induced Cardiac Dysfunction.

Introduction and Objectives: Cancer therapy-related cardiac dysfunction (CTRCD) is a common cause of cancer treatment withdrawal, related to the poor outcomes. The cardiac-specific treatment could recover the left ventricular ejection fraction (LVEF). We analyzed the clinical profile and prognosis of patients with CTRCD in a real-world scenario. Methods: A retrospective study that include all the cancer patients diagnosed with CTRCD, defined as LVEF < 50%. We analyzed the cardiac and oncologic treatments, the predictors of mortality and LVEF recovery, hospital admission, and the causes of mortality (cardiovascular (CV), non-CV, and cancer-related). Results: We included 113 patients (82.3% women, age 49.2 ± 12.1 years). Breast cancer (72.6%) and anthracyclines (72.6%) were the most frequent cancer and treatment. Meantime to CTRCD was 8 months, with mean LVEF of 39.4 ± 9.2%. At diagnosis, 27.4% of the patients were asymptomatic. Cardiac-specific treatment was started in 66.4% of patients, with LVEF recovery-rate of 54.8%. Higher LVEF at the time of CTRCD, shorter time from cancer treatment to diagnosis of CTRCD, and younger age were the predictors of LVEF recovery. The hospitalization rate was 20.4% (8.8% linked to heart failure). Treatment with trastuzumab and lower LVEF at diagnosis of CTRCD were the predictors of mortality. Thirty point nine percent of patients died during the 26 months follow-up. The non-CV causes and cancer-related were more frequent than CV ones. Conclusions: Cardiac-specific treatment achieves LVEF recovery in more than half of the patients. LVEF at the diagnosis of CTRCD, age, and time from the cancer treatment initiation to CTRCD were the predictors of LVEF recovery. The CV-related deaths were less frequent than the non-CV ones. Trastuzumab treatment and LVEF at the time of CTRCD were the predictors of mortality.

Caracterización de pacientes diagnosticados con sepsis en una unidad de cuidados intensivos de Bucaramanga, Colombia 2010-2011: estudio descriptivo / Characterizing patients with diagnosis of sepsis in an intensive care unit, at Bucaramanga, Colombia 2010-2011

Objetivo: describir las características clínicas y epidemiológicas de los pacientes con infección y cuadros de sepsis, sepsis severa o shock séptico, al interior de la UCI de una institución de cuarto nivel. La sepsis, sepsis severa y shock séptico son cuadros clínicos de incidencia creciente en las Unidades de Cuidado Intensivo, por lo que se hace necesario estudiar sus características y buscar alternativas costo-eficientes para el diagnóstico oportuno y abordaje racional. Materiales y Métodos: estudio observacional, descriptivo. A partir de una ficha estándar se recopiló y sistematizó información relevante sobre los pacientes ingresados a la UCI entre junio de 2010 y mayo de 2011; En total se incluyeron 97 sujetos, se evaluaron variables sociodemográficas, antecedentes, comorbilidad, duración de la estancia, complicaciones y estado al egreso de la Unidad. Resultados. 64,9% Masculino; promedio de edad 49 años, media deestancia 19 días. Tasa de mortalidad global de 39,6% (IC95%: 29,7-50,0%); 68,0%(n=66; IC95%: 58,2-77,8%), ingresó con un diagnóstico de infección; en 14,4% (n=14)de los casos el diagnóstico de sepsis se hizo antes del ingreso a la UCI; en 67,0%(n= 65), al ingreso o hasta 24 horas después; en 18,5% (n=18), transcurridos dos omás días del ingreso a la UCI. Las infecciones más frecuentes fueron neumonías e intraabdominales. Las complicaciones más frecuentes fueron la falla renal (59%) Insuficiencia respiratoria (16%) injuria pulmonar aguda (11%) y falla multisistémica (7%).Conclusiones: es necesario profundizar en el diseño de técnicas de diagnóstico y estrategias de manejo que faciliten la identificación precoz de la sepsis.

Objective: describe clinical and epidemiological characteristics of patients with infectionand diagnosis of sepsis, severe sepsis or septic shock, within an intensive careunit at a Hospital of fourth level of complexity. Sepsis, severe sepsis and septic shockare clinical disorders of increasing incidence in intensive care units; so, it is necessary to assess their characteristics and look for cost-efficient alternatives for the early diagnosis and rational approach. Materials and methods: descriptive, observational study. Initiating with the design of a standard questioner, were collected and recordedrelevant information about patients admitted to the intensive care unit, between June2010 and May 2011; In total 97 subjects were included. Were evaluated sociodemographic data, comorbidity, length of stay, complications, and alive or death status at the moment of discharge from the intensive care unit. Results: Mean age 49 years, meanlength of stay 19 days. Overall mortality rate of 39.6% (IC95%: 29,7-50,0%); 68,0%(n=66; IC95%: 58,2-77,8%), was admitted with a diagnosis of infection; in 14.4% (n= 14) of cases the diagnosis of sepsis was made before admission to intensive care unit; in 67.0% (n = 65), in the moment of the admission or up to 24 hours; 18.5% (n =18), two or more days after admission to the intensive care unit. The most common infections were pneumonia and intraabdominal. The most frequent complications wereacute renal failure (59%), respiratory failure (16%) acute lung injury (11%) and multiple organ failure (7%). Conclusions: It is necessary to deepen the design of diagnostic techniques to easy and early identification of sepsis.

La pandemia de gripa de 1918 en Bogotá / The 1918 influenza epidemics in Bogotá

Se pretende conocer a partir de diversas fuentes primarias (principalmente documentos oficiales, informes de la "Junta de Socorros", y prensa general y médica) cómo la gripe de 1918 alteró la dinámica social de Bogotá con particular atención a su impacto en términos de morbi-mortalidad, así como al análisis de cómo las condiciones sanitarias, las decisiones político-administrativas y las reacciones en sectores sociales influyeron e la respuesta de esta colectividad humana a la pandemia.(AU)