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1.
Am Heart J ; 226: 49-59, 2020 May 13.
Artigo em Inglês | MEDLINE | ID: covidwho-547998

RESUMO

Angiotensin-converting enzyme-2 (ACE2) expression may increase due to upregulation in patients using angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs). Because renin-angiotensin system blockers increase levels of ACE2, a protein that facilitates coronavirus entry into cells, there is concern that these drugs could increase the risk of developing a severe and fatal form of COVID-19. The impact of discontinuing ACEI and ARBs in patients with COVID-19 remains uncertain. DESIGN: BRACE CORONA is a pragmatic, multicenter, randomized, phase IV, clinical trial that aims to enroll around 500 participants at 34 sites in Brazil. Participants will be identified from an ongoing national registry of suspected and confirmed cases of COVID-19. Eligible patients using renin-angiotensin system blockers (ACEI/ARBs) with a confirmed diagnosis of COVID-19 will be randomized to a strategy of continued ACEI/ARB treatment versus temporary discontinuation for 30 days. The primary outcome is the median days alive and out of the hospital at 30 days. Secondary outcomes include progression of COVID-19 disease, all-cause mortality, death from cardiovascular causes, myocardial infarction, stroke, transient ischemic attack, new or worsening heart failure, myocarditis, pericarditis, arrhythmias, thromboembolic events, hypertensive crisis, respiratory failure, hemodynamic decompensation, sepsis, renal failure, and troponin, B-type natriuretic peptide (BNP), N-terminal-proBNP, and D-dimer levels. SUMMARY: BRACE CORONA will evaluate whether the strategy of continued ACEI/ARB therapy compared with temporary discontinuation of these drugs impacts clinical outcomes among patients with COVID-19.

2.
Am Heart J ; 226: 49-59, 2020 May 13.
Artigo em Inglês | MEDLINE | ID: covidwho-245496

RESUMO

Angiotensin-converting enzyme-2 (ACE2) expression may increase due to upregulation in patients using angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs). Because renin-angiotensin system blockers increase levels of ACE2, a protein that facilitates coronavirus entry into cells, there is concern that these drugs could increase the risk of developing a severe and fatal form of COVID-19. The impact of discontinuing ACEI and ARBs in patients with COVID-19 remains uncertain. DESIGN: BRACE CORONA is a pragmatic, multicenter, randomized, phase IV, clinical trial that aims to enroll around 500 participants at 34 sites in Brazil. Participants will be identified from an ongoing national registry of suspected and confirmed cases of COVID-19. Eligible patients using renin-angiotensin system blockers (ACEI/ARBs) with a confirmed diagnosis of COVID-19 will be randomized to a strategy of continued ACEI/ARB treatment versus temporary discontinuation for 30 days. The primary outcome is the median days alive and out of the hospital at 30 days. Secondary outcomes include progression of COVID-19 disease, all-cause mortality, death from cardiovascular causes, myocardial infarction, stroke, transient ischemic attack, new or worsening heart failure, myocarditis, pericarditis, arrhythmias, thromboembolic events, hypertensive crisis, respiratory failure, hemodynamic decompensation, sepsis, renal failure, and troponin, B-type natriuretic peptide (BNP), N-terminal-proBNP, and D-dimer levels. SUMMARY: BRACE CORONA will evaluate whether the strategy of continued ACEI/ARB therapy compared with temporary discontinuation of these drugs impacts clinical outcomes among patients with COVID-19.

3.
Am Heart J ; 226: 49-59, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32502882

RESUMO

Angiotensin-converting enzyme-2 (ACE2) expression may increase due to upregulation in patients using angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs). Because renin-angiotensin system blockers increase levels of ACE2, a protein that facilitates coronavirus entry into cells, there is concern that these drugs could increase the risk of developing a severe and fatal form of COVID-19. The impact of discontinuing ACEI and ARBs in patients with COVID-19 remains uncertain. DESIGN: BRACE CORONA is a pragmatic, multicenter, randomized, phase IV, clinical trial that aims to enroll around 500 participants at 34 sites in Brazil. Participants will be identified from an ongoing national registry of suspected and confirmed cases of COVID-19. Eligible patients using renin-angiotensin system blockers (ACEI/ARBs) with a confirmed diagnosis of COVID-19 will be randomized to a strategy of continued ACEI/ARB treatment versus temporary discontinuation for 30 days. The primary outcome is the median days alive and out of the hospital at 30 days. Secondary outcomes include progression of COVID-19 disease, all-cause mortality, death from cardiovascular causes, myocardial infarction, stroke, transient ischemic attack, new or worsening heart failure, myocarditis, pericarditis, arrhythmias, thromboembolic events, hypertensive crisis, respiratory failure, hemodynamic decompensation, sepsis, renal failure, and troponin, B-type natriuretic peptide (BNP), N-terminal-proBNP, and D-dimer levels. SUMMARY: BRACE CORONA will evaluate whether the strategy of continued ACEI/ARB therapy compared with temporary discontinuation of these drugs impacts clinical outcomes among patients with COVID-19.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Ensaios Clínicos Pragmáticos como Assunto , Brasil , Ensaios Clínicos Fase IV como Assunto , Humanos , Pacientes Internados , Estudos Multicêntricos como Assunto , Pandemias , Peptidil Dipeptidase A/metabolismo , Ensaios Clínicos Controlados Aleatórios como Assunto , Sistema Renina-Angiotensina/fisiologia , Integração Viral , Suspensão de Tratamento
4.
Am J Cardiovasc Drugs ; 15(6): 387-93, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26239259

RESUMO

Careful review of the literature of the last 20 years since the appearance of the first positive trials in heart failure indicates an evolution in the mode of death moving from sudden death to a predominance of pump failure death (i.e., death due to progression of heart failure). Pump failure is becoming a leading cause of mortality in a range of patient profiles, including patients with newly diagnosed or severe heart failure, patients with devices, and patients with heart failure associated with Chagas' disease. Indeed, the evidence suggests that modern management strategies, such as beta-blockers and devices, are successful in preventing sudden death. However, this means that optimally treated patients are at greater risk for the consequences of pump failure (death, hospitalization, and reduced quality of life). This highlights a new important unmet need in heart failure, and a priority for current research should be therapies that reduce pump failure death and hospitalization for more cost-effective management of the disease. Insofar as one-third of heart failure patients do not survive more than 3 years after diagnosis, properly addressing pump failure is an essential target in heart failure.


Assuntos
Causas de Morte , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Antagonistas Adrenérgicos beta/uso terapêutico , Terapia de Ressincronização Cardíaca , Ensaios Clínicos como Assunto , Desfibriladores Implantáveis , Insuficiência Cardíaca/fisiopatologia , Humanos , Estimativa de Kaplan-Meier , Estudos Observacionais como Assunto , Qualidade de Vida , Fatores de Risco
5.
Arq Bras Cardiol ; 94(3): 286-92, 306-12, 2010 Mar.
Artigo em Inglês, Português | MEDLINE | ID: mdl-20730255

RESUMO

BACKGROUND: There is a scarcity of cost-effectiveness analyses in the national literature comparing drug-eluting stents (DES) with bare-metal stents (BMS), at late follow-up. OBJECTIVE: To estimate the Incremental Cost-Effectiveness Ratio (ICER) between DES and BMS in uniarterial coronariopathy. METHODS: 217 patients (130 DES and 87 BMS), with 48 months of follow-up (mean = 26 months) were assessed. PRIMARY OUTCOME: cost per prevented restenosis, with effectiveness being defined as the decrease in major events. The analytical model of decision was based on the study by Polanczyk et al. The direct costs were those used directly in the interventions. RESULTS: The sample was homogenous for age and sex. The DES was more used in diabetic patients: 59 (45.4%) vs 16 (18.4%)(p<0.0001) and with a history of coronary artery disease (CAD): 53 (40.7%) vs 13 (14.9%)(p<0.0001). The BMS was more used in simple lesions, but with worse ventricular function. The DES were implanted preferentially in proximal lesions: (p=0.0428) and the BMS in the mid-third (p=0.0001). Event-free survival: DES = 118 (90.8%) vs BMS=74 (85.0%) (p=0.19); Angina: DES=9 (6.9%) vs BMS=9 (10.3%) (NS): Clinical restenosis: DES=3 (2.3%) vs BMS=10 (10.3%) (p=0.0253). Cardiac deaths: 2 (1.5%) in DES and 3 (3.5%) in BMS (NS). COSTS: the tree of decision was modeled based on restenosis. The net benefit for the DES needed an increment of R$7,238.16. The ICER was R$131,647.84 per prevented restenosis (above the WHO threshold). CONCLUSIONS: The DES was used in more complex lesions. The clinical results were similar. The restenosis rate was higher in the BMS group. The DES was a non-cost-effective strategy.


Assuntos
Doença das Coronárias/terapia , Stents Farmacológicos/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Intervalo Livre de Doença , Fatores Epidemiológicos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estatísticas não Paramétricas , Resultado do Tratamento , Função Ventricular
6.
Arq Bras Cardiol ; 90(5): 324-8, 2008 May.
Artigo em Inglês, Português | MEDLINE | ID: mdl-18516403

RESUMO

BACKGROUND: The nonpharmacological management of heart failure (HF) has been understudied. The importance of micronutrients such as thiamine has long been known since its deficiency is associated with the development of high-output HF. OBJECTIVE: We studied the relationship between adding to ACE inhibition further aldosterone suppression with spironolactone and thiamine blood levels (pmol/ml). METHODS: A total of 22 patients (pts) with HF (NYHA III/IV) were divided in two groups [group I-spironolactone 25mg/qd (n=11) and group II - no spironolactone (n=11)]. Thiamine levels were determined using the erythrocyte transketolase activity. The groups were compared regarding food intake, demographics, furosemide doses and thiamine blood levels using Mann-Whitney and student's T-test. The proportions were analyzed with Chi-square and Kruskal-Wallis tests to associate thiamine with demographics and furosemide doses as dependent variables. RESULTS: Group I and II were similar regarding food intake, daily furosemide doses (110.9+/-30.2 and 105.5+/-26.9 mg, respectively; p>0.05), demographics (etiology, age, hypertension, diabetes, smoking, alcohol abuse, dyslipidemia and adjuvant drug HF treatment). Pts in group I showed significantly higher thiamine levels when compared to pts in group II (277.2+/-89.8 and 154.7+/-35.7, respectively) (p<0.001). None of the dependent variables cited above were associated with thiamine. CONCLUSION: In a cohort of ambulatory HF patients on high dose of loop diuretics, the use of spironolactone is associated with higher thiamine blood levels. The significance of this finding remains to be established by future studies with prospective design and larger sample sizes.


Assuntos
Diuréticos/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Espironolactona/uso terapêutico , Deficiência de Tiamina/diagnóstico , Tiamina/sangue , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Doença Crônica , Estudos Transversais , Ingestão de Alimentos , Eritrócitos/enzimologia , Feminino , Furosemida/administração & dosagem , Insuficiência Cardíaca/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Estatísticas não Paramétricas , Transcetolase/metabolismo
7.
Tex Heart Inst J ; 30(3): 176-9, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12959198

RESUMO

In cases of chronic congestive heart failure, QT-interval dispersion is a strong predictor of death. Carvedilol therapy appears to decrease QT-interval dispersion. We investigated whether carvedilol reduces QT-interval dispersion in congestive heart failure and whether this pharmaceutical agent has additional effects on elderly patients. Seventy-seven ambulatory patients who had chronic congestive heart failure were evaluated for hypertension, diabetes mellitus, smoking, alcohol abuse, concomitant medications, and QT-interval dispersion. Carvedilol therapy was then initiated. Six months later, we re-evaluated the same variables, as well as morbidity and mortality rates, and number of hospitalizations. The patients were divided into 2 groups: Group I, aged < 65 years (n = 42); and Group II, aged > or = 65 years (n = 35). Statistics were analyzed with the Student's t-test chi2 test, and Cox regression model. At 6 months, both groups showed significantly decreased QT-interval dispersion values compared with baseline values (76.9 +/- 29.3 vs 104.3 +/- 41.5 ms, respectively; P < 0.0001). An elevated QT-interval dispersion value at baseline increased morbidity (P = 0.041) but not hospitalization (P > 0.05). Group II had a smaller reduction in QT-interval dispersion than did Group I (24.41 +/- 29.36 and 30.98 +/- 32.70 ms, respectively), but this difference was not significant. We conclude that in ambulatory patients with chronic congestive heart failure, long-term carvedilol therapy significantly decreases QT-interval dispersion, and this effect is uniformly distributed between patients aged < 65 years and those aged 265 years.


Assuntos
Antagonistas Adrenérgicos beta/administração & dosagem , Carbazóis/administração & dosagem , Eletrocardiografia/efeitos dos fármacos , Insuficiência Cardíaca/tratamento farmacológico , Propanolaminas/administração & dosagem , Adulto , Fatores Etários , Idoso , Carvedilol , Feminino , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida
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