Efficacy and Safety of Text Messages Targeting Adherence to Cardiovascular Medications in Secondary Prevention: TXT2HEART Colombia Randomized Controlled Trial.

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality worldwide, with a prevalence of approximately 100 million patients. There is evidence that antiplatelet agents and antihypertensive medications could reduce the risk of new vascular events in this population; however, treatment adherence is very low. An SMS text messaging intervention was recently developed based on behavior change techniques to increase adherence to pharmacological treatment among patients with a history of ASCVD. OBJECTIVE: This study aims to evaluate the efficacy and safety of an SMS text messaging intervention to improve adherence to cardiovascular medications in patients with ASCVD. METHODS: A randomized controlled clinical trial for patients with a prior diagnosis of cardiovascular events, such as acute myocardial infarction, unstable angina, cerebrovascular disease, or peripheral artery disease, in one center in Colombia was conducted. Patients randomized to the intervention arm were assigned to receive SMS text messages daily for the first 4 weeks, 5 SMS text messages on week 5, 3 SMS text messages each in weeks 6 and 7, and 1 SMS text message weekly from week 8 until week 52. In contrast, patients in the control arm received a monthly SMS text message reminding them of the next study appointment and the importance of the study, requesting information about changes in their phone number, and thanking them for participating in the study. The primary endpoint was the change in low-density lipoprotein cholesterol (LDL-C) levels, whereas the secondary endpoints were the changes in thromboxane B2 levels, heart rate, systolic and diastolic blood pressure, medication adherence, cardiac and noncardiac mortality, and hospitalization. Linear regression analyses and bivariate tests were performed. RESULTS: Of the 930 randomized patients, 805 (86.5%) completed follow-up and were analyzed for the primary endpoint. There was no evidence that the intervention changed the primary outcome (LDL-C levels; P=.41) or any of the secondary outcomes evaluated (all P>.05). There was also no evidence that the intervention was associated with adverse events. CONCLUSIONS: In this study, there was no evidence that a behavior modification intervention delivered by SMS text messaging improved LDL-C levels, blood pressure levels, or adherence at 12 months. More research is needed to evaluate whether different SMS text messaging strategies, including personalized messages and different timings, are effective; future studies should include mixed methods to better understand why, for whom, and in which context (eg, health system or social environment) SMS text messaging interventions work (or not) to improve adherence in patients with ASCVD. TRIAL REGISTRATION: ClinicalTrials.gov NCT03098186; https://clinicaltrials.gov/ct2/show/NCT03098186. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2018-028017.

Tratamiento intervencionista de la estenosis mitral / Interventional treatment of mitral stenosis

Las secuelas de la fiebre reumática son prevalentes en la población colombiana. La causa más frecuente de estenosis mitral es la fiebre reumática y afecta predominantemente a mujeres desde la edad fértil hasta la vejez. Aunque el curso es usualmente más benigno en las mujeres, la población masculina con fiebre reumática también tiene una alta incidencia de complicaciones y secuelas. La estenosis mitral es una enfermedad de instalación lenta, se inicia con episodios clínicos o más frecuentemente subclínicos de carditis reumática, que se suelen acompañar de insuficiencia plurivalvular y posteriormente aparece la estenosis mitral que suele manifestarse inicialmente como disnea de ejercicio. En la medida que progresa la estenosis, la disnea se acentúa y se acompaña de cambios hemodinámicos importantes como aumento de presión en la aurícula izquierda, que se transmite a la circulación pulmonar produciendo hipertensión pulmonar que podría llevar hasta falla cardiaca derecha con dilatación del ventrículo derecho (VD) e insuficiencia tricuspídea orgánica o funcional. La aurícula izquierda se distiende y se asocia frecuentemente con la aparición de fibrilación auricular. Esta asociación produce baja velocidad de flujo y éstasis de la sangre en la aurícula izquierda actuando como fenómeno protrombótico, donde la primera manifestación clínica puede ser una embolia sistémica hasta en 15% de los casos, la más frecuente al sistema nervioso central con secuelas usualmente devastadoras, particularmente en la población joven.

Aorto-right atrial fistula secondary to rupture of an occluded old saphenous venous graft to right coronary artery.

We report a case of an acquired aorta-right atrial fistula, secondary to a ruptured proximal anastomosis of an old saphenous vein graft 12 years after a coronary artery bypass surgery, in a 57 year old patient with multiple cardiovascular risk factors. On admission, he presented with congestive heart failure and on examination a continuous murmur was detected on the right parasternal border. Catheterization showed a fistula from the proximal anastomosis of an occluded right coronary artery saphenous vein graft draining to the right atrium with a large left to right shunt. The fistula was successfully occluded by a percutaneous approach with a Life Tech duct occluder with complete resolution of heart failure. The patient was discharged one week afterwards. After a two-year follow-up, the fistula remained occluded.

Early results after synchronous carotid stent placement and coronary artery bypass graft in patients with asymptomatic carotid stenosis.

BACKGROUND: The optimal management of patients with combined carotid and coronary artery disease requiring cardiac surgery is still unknown. Staged carotid endarterectomy and carotid artery stenting (CAS), each followed by coronary artery bypass graft (CABG), are options frequently employed. However, for patients with severe carotid artery disease in urgent need of open cardiac revascularization, staged operations may not be the most appropriate alternative. The aim of this study was to describe our experience using a synchronous CAS-CABG method with minimal interprocedural time. We used this synchronous combination of procedures in patients with combined carotid and coronary artery disease admitted for urgent CABG. METHODS: Patients with concomitant severe carotid and coronary artery disease scheduled for synchronous CAS and urgent CABG between December 2006 and January 2010 were included in the study. All procedures were performed at a single center: the Cardiovascular Foundation of Colombia, in Floridablanca, Santander, Colombia. The study cohort was characterized according to demographic and clinical characteristics, which included degree of carotid stenosis, presence/absence of preoperative neurological symptoms, and cardiac operative risk profile. All patients underwent CAS under embolic protection devices and then CABG within the next 2 hours. Patients received aspirin pre- and postprocedure but were started on clopidogrel only after CABG. The primary end point of the study was the composite incidence rate of myocardial infarction, stroke, and death 30 days after CAS-CABG. RESULTS: Fifteen patients with concomitant severe carotid and coronary artery disease underwent synchronous CAS-CABG. Most patients (60%) were men, and mean (± standard deviation) age was 65.2 (± 8.4) years. Most patients (93%) were neurologically asymptomatic. The median (interquartile range) ejection fraction and logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) for the cohort were 55% (36%-62%) and 9.7% (4.6%-14.8%), respectively. There were no deaths, major strokes, minor strokes, or myocardial infarctions during the procedure or within 30 days of CAS-CABG. One patient experienced neurological symptoms likely as a result of transient ischemic attack ipsilateral to the CAS procedure. None of the patients required cardiac or carotid reinterventions, and there were no cases of postoperative bleeding requiring reoperation. CONCLUSIONS: Synchronous CAS-CABG, when CABG is performed within the 2 hours of the CAS procedure, may be a viable alternative to the more generally accepted staged combination, particularly among patients for whom CABG cannot be postponed. We hope that this strategy will be further evaluated in larger prospective studies and adequately powered randomized clinical trials.

Quimioembolización intraarterial hepática supraselectiva transitoria en pacientes con hepatocarcinoma o metástasis a hígado con primario controlado / Liver intraarterial transient supraselective chemoembolization in patients with primary liver cancer or liver metastasic cancer with primary controlled

Antecedentes: No existe tratamiento estándar para adversos fueron mínimos, transitorios y de fácil manejopacientes con carcinoma hepatocelular o metástasis médico, sin presencia de efectos hematológicos. Solo unhepática no erradicable con primario controlado pero que paciente presentó síndrome postquimioembolización. Elhan fallado al tratamiento sistémico. Se presenta la tiempo medio de de seguimiento fue de 11.2 meses, conexperiencia del tratamiento con quimioembolización mediana de sobrevida de 16 meses y sobrevida a 2 años deintraarterial hepática supraselectiva (QEIAHS) realizado en 27%. En todos los pacientes desapareció el dolor,la Unidad de Oncología del Hospital Universitario de mantuvieron estado funcional grado 0 y 1, permaneciendoSantander, Bucaramanga, Colombia. Metodología: Se activos y con buenos niveles de autocuidado durante elrevisaron las historias clínicas de los pacientes atendidos periodo de sobrevida, estando generalmente asintomáticos.entre marzo de 2000 a marzo de 2007...

Background: There is no standard treatment for patients patient presented postchemoemboembolization syndrome.with unresectable primary liver carcinoma or liver Average follow-up time was 11.2 months, and medianmetastasic cancer with controlled primary and failed survival time was 16 months, with global survival to twosystemic treatment. Methodology: Review charts from six years of 27%. Functional states remained between 0 and 1patients treated with liver intraarterial transient degree, being generally asymptomatic. In all patientssupraselective chemoembolization (LITSC) in the Oncology abdominal pain disappear, performance status had grade 0Unit, University Hospital of Santander, Bucaramanga, and 1, all remain active and with good levels of self-care andColombia between March 2000 to March 2007...