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1.
Int Heart J ; 61(5): 1005-1013, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32999188

RESUMO

This study sought to evaluate clinical features, treatment patterns, and outcomes of patients with idiopathic inflammatory myopathy (IIM) complicated by heart failure (HF). Thirty-two patients with IIM-HF admitted to the Peking Union Medical College Hospital between January 1999 and January 2018 were retrospectively reviewed, including 14 patients with polymyositis, 11 with dermatomyositis, and 7 with overlap syndrome. Survivors and no-survivors were compared on clinical characteristics and treatment. Although systemic symptoms were variable, all patients presented with elevated troponin I. Rapid atrial arrhythmia was the most frequent arrhythmia. Systolic dysfunction and restrictive diastolic dysfunction were typical presentations in echocardiography. Twenty-nine patients were followed up for a median of 2.8 years (0.1 month to 11 years). We recorded 13 deaths of cardiogenic cause, 1 of serious IIM, and 3 of infective complications. The median survival time from diagnosis of IIM-HF to all-cause mortality was 8.4 months (range from 1 month to 5 years). Both all-cause deaths and cardiogenic deaths were more reported in the methotrexate-alone group than in the combination therapy group (6/7 versus 3/10, P = 0.050; 5/6 versus 2/9, P = 0.041). Combination therapy including methotrexate (HR = 0.188, 95%CI 0.040-0.871, P = 0.033) and taking ß-receptor blockers (HR = 0.249, 95%CI 0.086-0.719, P = 0.010) was associated with reduced risk of all-cause deaths. In conclusion, elevated troponin I, atrial arrhythmia, and systolic and restrictive diastolic dysfunction are typical characteristics of IIM-HF. Combined immunosuppression that includes methotrexate and ß-receptor blockers seems to be important to improve survival.


Assuntos
Imunossupressores/uso terapêutico , Metotrexato/uso terapêutico , Miosite/tratamento farmacológico , Miosite/mortalidade , Adolescente , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Idoso , China/epidemiologia , Quimioterapia Combinada , Feminino , Glucocorticoides/uso terapêutico , Insuficiência Cardíaca/etiologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Miosite/complicações , Estudos Retrospectivos , Adulto Jovem
2.
Ann Saudi Med ; 40(5): 365-372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32954790

RESUMO

Evidence of cardiovascular complications associated with the COVID-19 global pandemic continues to evolve. These include direct and indirect myocardial injury with subsequent acute myocardial ischemia, and cardiac arrhythmia. Some results from a limited number of trials of antiviral medications, along with chloroquine/hydroxychloroquine and azithromycin, have been beneficial. However, these pharmacotherapies may cause drug-induced QT prolongation leading to ventricular arrhythmias and sudden cardiac death. Mitigation of the potential risk in these susceptible patients may prove exceptionally challenging. The Saudi Heart Rhythm Society established a task force to perform a review of this subject based on has recently published reports, and studies and recommendations from major medical organizations. The objective of this review is to identify high-risk patients, and to set clear guidelines for management of patients receiving these pharmacotherapies.


Assuntos
Arritmias Cardíacas/induzido quimicamente , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Antagonistas Adrenérgicos beta/uso terapêutico , Comitês Consultivos , Antivirais/efeitos adversos , Arritmias Cardíacas/diagnóstico , Azitromicina/efeitos adversos , Betacoronavirus , Cloroquina/efeitos adversos , Inibidores do Citocromo P-450 CYP2D6/efeitos adversos , Combinação de Medicamentos , Interações Medicamentosas , Monitoramento de Medicamentos , Eletrocardiografia , Humanos , Hidroxicloroquina/efeitos adversos , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/diagnóstico , Lopinavir/efeitos adversos , Pandemias , Medição de Risco , Ritonavir/efeitos adversos , Arábia Saudita , Torsades de Pointes/induzido quimicamente , Torsades de Pointes/diagnóstico
3.
Lancet ; 396(10253): 759-769, 2020 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-32871100

RESUMO

BACKGROUND: Cardiac muscle hypercontractility is a key pathophysiological abnormality in hypertrophic cardiomyopathy, and a major determinant of dynamic left ventricular outflow tract (LVOT) obstruction. Available pharmacological options for hypertrophic cardiomyopathy are inadequate or poorly tolerated and are not disease-specific. We aimed to assess the efficacy and safety of mavacamten, a first-in-class cardiac myosin inhibitor, in symptomatic obstructive hypertrophic cardiomyopathy. METHODS: In this phase 3, randomised, double-blind, placebo-controlled trial (EXPLORER-HCM) in 68 clinical cardiovascular centres in 13 countries, patients with hypertrophic cardiomyopathy with an LVOT gradient of 50 mm Hg or greater and New York Heart Association (NYHA) class II-III symptoms were assigned (1:1) to receive mavacamten (starting at 5 mg) or placebo for 30 weeks. Visits for assessment of patient status occurred every 2-4 weeks. Serial evaluations included echocardiogram, electrocardiogram, and blood collection for laboratory tests and mavacamten plasma concentration. The primary endpoint was a 1·5 mL/kg per min or greater increase in peak oxygen consumption (pVO2) and at least one NYHA class reduction or a 3·0 mL/kg per min or greater pVO2 increase without NYHA class worsening. Secondary endpoints assessed changes in post-exercise LVOT gradient, pVO2, NYHA class, Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score (KCCQ-CSS), and Hypertrophic Cardiomyopathy Symptom Questionnaire Shortness-of-Breath subscore (HCMSQ-SoB). This study is registered with ClinicalTrials.gov, NCT03470545. FINDINGS: Between May 30, 2018, and July 12, 2019, 429 adults were assessed for eligibility, of whom 251 (59%) were enrolled and randomly assigned to mavacamten (n=123 [49%]) or placebo (n=128 [51%]). 45 (37%) of 123 patients on mavacamten versus 22 (17%) of 128 on placebo met the primary endpoint (difference +19·4%, 95% CI 8·7 to 30·1; p=0·0005). Patients on mavacamten had greater reductions than those on placebo in post-exercise LVOT gradient (-36 mm Hg, 95% CI -43·2 to -28·1; p<0·0001), greater increase in pVO2 (+1·4 mL/kg per min, 0·6 to 2·1; p=0·0006), and improved symptom scores (KCCQ-CSS +9·1, 5·5 to 12·7; HCMSQ-SoB -1·8, -2·4 to -1·2; p<0·0001). 34% more patients in the mavacamten group improved by at least one NYHA class (80 of 123 patients in the mavacamten group vs 40 of 128 patients in the placebo group; 95% CI 22·2 to 45·4; p<0·0001). Safety and tolerability were similar to placebo. Treatment-emergent adverse events were generally mild. One patient died by sudden death in the placebo group. INTERPRETATION: Treatment with mavacamten improved exercise capacity, LVOT obstruction, NYHA functional class, and health status in patients with obstructive hypertrophic cardiomyopathy. The results of this pivotal trial highlight the benefits of disease-specific treatment for this condition. FUNDING: MyoKardia.


Assuntos
Benzilaminas/uso terapêutico , Miosinas Cardíacas/antagonistas & inibidores , Cardiomiopatia Hipertrófica/tratamento farmacológico , Uracila/análogos & derivados , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Benzilaminas/efeitos adversos , Bloqueadores dos Canais de Cálcio/uso terapêutico , Cardiomiopatia Hipertrófica/fisiopatologia , Fármacos Cardiovasculares/uso terapêutico , Método Duplo-Cego , Tolerância ao Exercício/fisiologia , Feminino , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Avaliação de Resultados da Assistência ao Paciente , Uracila/efeitos adversos , Uracila/uso terapêutico
4.
Medicine (Baltimore) ; 99(39): e22301, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991436

RESUMO

RATIONALE: Cardiotoxicity related to osimertinib, including cardiac failure, QT prolongation, and atrial fibrillation, has been reported as an extremely rare incidence in patients with advanced non-small cell lung cancer (NSCLC). However, little is known about the occurrence of osimertinib-induced cardiomyopathy. PATIENT CONCERNS: A 76-year old woman was treated with afatinib (40 mg/day) as the 1st line treatment due to recurrence after surgical resection for pulmonary adenocarcinoma. However, she experienced recurrence with positive T790 M, and osimertinib (80 mg/day) was administered as the 2nd line therapy. DIAGNOSIS: Four months after osimertinib initiation, she complained of fever and progressive dyspnea, and a diagnostic endomyocardial biopsy confirmed non-specific cardiomyopathy, indicating osimertinib-induced cardiomyopathy. INTERVENTIONS AND OUTCOMES: She was treated with furosemide, carvedilol, and enalapril, and her cardiac function, her symptoms, and condition improved 3 weeks after the withdrawal of osimertinib. LESSONS: Physicians should be alert of the cardiomyopathy-causing potential of osimertinib in advanced NSCLC patients.


Assuntos
Acrilamidas/efeitos adversos , Compostos de Anilina/efeitos adversos , Cardiomiopatias/induzido quimicamente , Inibidores de Proteínas Quinases/efeitos adversos , Acrilamidas/uso terapêutico , Adenocarcinoma de Pulmão/tratamento farmacológico , Antagonistas Adrenérgicos beta/uso terapêutico , Afatinib/uso terapêutico , Idoso , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Compostos de Anilina/uso terapêutico , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/fisiopatologia , Carvedilol/uso terapêutico , Diuréticos/uso terapêutico , Enalapril/uso terapêutico , Feminino , Furosemida/uso terapêutico , Humanos , Neoplasias Pulmonares/patologia , Inibidores de Proteínas Quinases/uso terapêutico , Recidiva , Resultado do Tratamento , Suspensão de Tratamento
5.
Cochrane Database Syst Rev ; 9: CD010054, 2020 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-32888198

RESUMO

BACKGROUND: Beta-blockers are commonly used in the treatment of hypertension. We do not know whether the blood pressure (BP) lowering efficacy of beta-blockers varies across the day. This review focuses on the subclass of beta-blockers with partial agonist activity (BBPAA). OBJECTIVES: To assess the degree of variation in hourly BP lowering efficacy of BBPAA over a 24-hour period in adults with essential hypertension. SEARCH METHODS: The Cochrane Hypertension Information Specialist searched the following databases for relevant studies up to June 2020: the Cochrane Hypertension Specialised Register; CENTRAL; 2020, Issue 5; MEDLINE Ovid; Embase Ovid; the World Health Organization International Clinical Trials Registry Platform; and ClinicalTrials.gov. We also contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions. SELECTION CRITERIA: We sought to include all randomised and non-randomised trials that assessed the hourly effect of BBPAA by ambulatory monitoring, with a minimum follow-up of three weeks. DATA COLLECTION AND ANALYSIS: Two review authors independently selected the included trials and extracted the data. We assessed the certainty of the evidence using the GRADE approach. Outcomes included in the review were end-point hourly systolic and diastolic blood pressure (SBP and DBP) and heart rate (HR), measured using a 24-hour ambulatory BP monitoring (ABPM) device. MAIN RESULTS: Fourteen non-randomised baseline controlled trials of BBPAA met our inclusion criteria, but only seven studies, involving 121 participants, reported hourly ambulatory BP data that could be included in the meta-analysis. Beta-blockers studied included acebutalol, pindolol and bopindolol. We judged most studies at high or unclear risk of bias for selection bias, attrition bias, and reporting bias. We judged the overall certainty of the evidence to be very low for all outcomes. We analysed and presented data by each hour post-dose. Very low-certainty evidence showed that hourly mean reduction in BP and HR visually showed an attenuation over time. Over the 24-hour period, the magnitude of SBP lowering at each hour ranged from -3.68 mmHg to -17.74 mmHg (7 studies, 121 participants), DBP lowering at each hour ranged from -2.27 mmHg to -9.34 mmHg (7 studies, 121 participants), and HR lowering at each hour ranged from -0.29 beats/min to -10.29 beats/min (4 studies, 71 participants). When comparing between three 8-hourly time intervals that correspond to day, evening, and night time hours, BBPAA was less effective at lowering BP and HR at night, than during the day and evening. However, because we judged that these outcomes were supported by very low-certainty evidence, further research is likely to have an important impact on the estimate of effect and may change the conclusion. AUTHORS' CONCLUSIONS: There is insufficient evidence to draw general conclusions about the degree of variation in hourly BP-lowering efficacy of BBPAA over a 24-hour period, in adults with essential hypertension. Very low-certainty evidence showed that BBPAA acebutalol, pindolol, and bopindolol lowered BP more during the day and evening than at night. However, the number of studies and participants included in this review was very small, further limiting the certainty of the evidence. We need further and larger trials, with accurate recording of time of drug intake, and with reporting of standard deviation of BP and HR at each hour.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Ritmo Circadiano/fisiologia , Hipertensão/tratamento farmacológico , Acebutolol/uso terapêutico , Agonistas Adrenérgicos beta/uso terapêutico , Adulto , Viés , Pressão Sanguínea/fisiologia , Ensaios Clínicos Controlados como Assunto , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pindolol/análogos & derivados , Pindolol/uso terapêutico , Fatores de Tempo
6.
Circ J ; 84(10): 1679-1685, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32908073

RESUMO

The health crisis due to coronavirus disease 2019 (COVID-19) has shocked the world, with more than 1 million infections and casualties. COVID-19 can present from mild illness to multi-organ involvement, but especially acute respiratory distress syndrome. Cardiac injury and arrhythmias, including atrial fibrillation (AF), are not uncommon in COVID-19. COVID-19 is highly contagious, and therapy against the virus remains premature and largely unknown, which makes the management of AF patients during the pandemic particularly challenging. We describe a possible pathophysiological link between COVID-19 and AF, and therapeutic considerations for AF patients during this pandemic.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Antiarrítmicos/uso terapêutico , Anticoagulantes/uso terapêutico , Antivirais/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/métodos , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/virologia , Citocinas/sangue , Interações Medicamentosas , Humanos , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , Risco
7.
Int Heart J ; 61(5): 1041-1043, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32879262

RESUMO

The current treatment of radiation-induced coronary artery disease (RCAD) is comparable to that of generic coronary artery disease (CAD); however, the outcomes of these treatment measures have not been fully examined in RCAD. A 33-year-old woman, without conventional cardiovascular risk factors, presented with left main coronary artery (LMCA) lesions. At the age of 26, she received mediastinal radiation therapy (RT) to treat mixed cellularity Hodgkin lymphoma. One BiodivYsio 3.5 × 18 mm stent was implanted at the LMCA site. At the age of 38, the patient was treated by balloon dilatation because of approximately 50% in-stent stenosis. At the last follow-up in February 2018, when the patient was 51 years old, she no longer complained of chest pain. Coronary angiography showed no de novo or in-stenosis lesions, although optical coherence tomography showed mild neointimal proliferation, calcific plaque, small ruptured intima, and several uncovered struts. The experience of treating this case may shed some light on coronary stenting in coronary lesions caused by RCAD.


Assuntos
Angioplastia Coronária com Balão , Doença da Artéria Coronariana/terapia , Reestenose Coronária/terapia , Doença de Hodgkin/radioterapia , Lesões por Radiação/terapia , Stents , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Reestenose Coronária/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Mediastino , Pessoa de Meia-Idade , Neointima/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Inibidores da Agregação de Plaquetas/uso terapêutico , Tomografia de Coerência Óptica
8.
Medicine (Baltimore) ; 99(38): e22368, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957413

RESUMO

BACKGROUND: The high recurrence rate of atrial fibrillation (AF) after recovering sinus rhythm has always been a clinical problem. Despite the established and widespread use of antiarrhythmic drugs, which one is better for maintaining sinus rhythm is still controversial. This study aims to summarize the randomized controlled trials (RCTs) of amiodarone combined with beta blockers to maintain sinus rhythm in AF, and to determine an effective and safe intervention for the prevention of AF recurrence through network meta-analysis (NMA). METHODS AND ANALYSIS: A comprehensive search of the RCTs comparing amiodarone with different beta-blockers to maintain sinus rhythm of AF patients will be conducted from the inception to December 2019 in the Cochrane Library, PubMed, Web of Science, EMBASE, Chinese Biomedical Literature Database (SinoMed), Chinese National Knowledge Infrastructure (CNKI), and WanFang database. The primary outcomes will be the recurrence of AF and frequency of embolization complications. The secondary outcomes will be the symptom improvements and adverse events. Risk of bias assessment of the included RCTs will be conducted according to the Cochrane collaboration's risk of bias tool. Pairwise meta-analyses and Bayesian network meta-analyses will be performed for all related outcome measures. GRADE will be used to evaluate the quality of evidence. RESULTS: The results of this NMA will be published in a peer-reviewed journal. CONCLUSION: This NMA may provide more recommendations for patients and researchers, such as which treatment is better for a particular case of AF, and what may be the hotspots for the future studies. PROSPERO REGISTRATION NUMBER: The protocol for this NMA has been registered on PROSPERO under the number CRD42020164438.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Quimioterapia Combinada , Humanos , Metanálise em Rede , Revisões Sistemáticas como Assunto
9.
G Ital Cardiol (Rome) ; 21(10): 750-756, 2020 Oct.
Artigo em Italiano | MEDLINE | ID: mdl-32968307

RESUMO

BACKGROUND: During the COVID-19 pandemic, non-urgent outpatient activities were temporarily suspended. The aim of this study was to assess the impact of this measure on the management of the heart failure outpatient clinic at our institution. METHODS: We analyzed the clinical outcome of 110 chronic heart failure patients (mean age 73 ± 9 years) whose follow-up visit had been delayed. RESULTS: At their last visit before the lockdown, 80.9% was in NYHA class II, had an ejection fraction of 37 ± 7%, and B-type natriuretic peptide level was moderately elevated (266 ± 138 pg/ml). All patients received loop diuretics, 97.2% beta-blockers, 64.9% an aldosterone antagonist, 60.9% sacubitril/valsartan (S/V), and 72.2% of the remaining patients were on angiotensin-converting enzyme inhibitor or valsartan therapy. Patients were contacted by phone during and at the end of the lockdown period to fix a new appointment and underwent a structured interview to assess their clinical conditions and ongoing therapy and to verify whether they had contracted SARS-CoV-2 infection. Twelve patients (13.2%) contracted COVID-19. None was hospitalized for worsening heart failure or reported defibrillator shocks and none changed autonomously the prescribed therapy. Overall, 75% of patients reported stable or improved general well-being from the last in-person visit, while 25% described subjective worsening due to the social effect of the pandemic. Unchanged body weight and blood pressure values were reported by 86% and 78.4% of patients, respectively. Lower blood pressure values compared to baseline were recorded in 15.2% of patients on conventional renin-angiotensin system inhibition vs 21% of those on S/V, one of whom had to down-titrate S/V for persistent but asymptomatic hypotension; 4 patients up-titrated S/V to 200 mg/day following phone indications. CONCLUSIONS: Cancellation of scheduled follow-up visits during 3 months did not have significant negative effects in a cohort of stable patients with chronic heart failure on optimized medical therapy. Telephone support was effective in keeping connections with the patients during the lockdown, allowing appropriate management and implementation of drug therapy. In particular, patients who received S/V were not affected by delays in scheduled visits, confirming the tolerability and safety of this novel therapy in terms of both clinical and biohumoral parameters.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Insuficiência Cardíaca/tratamento farmacológico , Pneumonia Viral/epidemiologia , Quarentena , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Instituições de Assistência Ambulatorial , Aminobutiratos/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Doença Crônica , Continuidade da Assistência ao Paciente/organização & administração , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/psicologia , Assistência à Saúde , Progressão da Doença , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/psicologia , Humanos , Itália/epidemiologia , Masculino , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Peptídeo Natriurético Encefálico/sangue , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/psicologia , Recidiva , Inibidores de Simportadores de Cloreto de Sódio e Potássio/uso terapêutico , Volume Sistólico , Telefone , Tetrazóis/uso terapêutico , Suspensão de Tratamento
10.
Klin Monbl Augenheilkd ; 237(10): 1241-1258, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32777830

RESUMO

Glaucoma is the leading cause of irreversible blindness in Germany and in the world. Due to the multifactorial genesis of the disease, there are multiple therapeutic approaches for preventing its progression. The goal of the commonly used topical glaucoma medication is to reduce the intraocular pressure and therefore prevent further damage to the optic nerve. There are different medications of various pharmacological classes that are intended to reduce intraocular pressure, namely, ß-adrenergic antagonists, adrenergic agonists, parasympathomimetic agents, prostaglandin analogues, carbonic anhydrase inhibitors, hyperosmotic agents, and the 2017 U. S. FDA approved Rho kinase inhibitor, Netarsudil.After determining a patient centered target pressure, which depends upon various factors, an individual treatment regimen should be chosen with one or more agents. Although reducing the intraocular pressure remains the main therapeutic focus, there is increasing evidence indicating that oxidative stress also plays a key role in the pathogenesis of the primary open angle glaucoma. Therefore, direct and indirect neuroprotective agents like Magnesium, Coenzym Q10, Ginkgo biloba and others are getting more and more attention. While there is still a need for further clinical trials, these substances are getting more popular as an adjunct in glaucoma therapy.


Assuntos
Glaucoma de Ângulo Aberto , Glaucoma , Antagonistas Adrenérgicos beta/uso terapêutico , Inibidores da Anidrase Carbônica/uso terapêutico , Alemanha , Glaucoma/tratamento farmacológico , Humanos , Pressão Intraocular
11.
Am Heart J ; 228: 44-46, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32771699

RESUMO

Recent results from the ISCHEMIA trial highlight the importance of medical management for patients with stable ischemic heart disease. We determine the prevalence of angina in the United States, as well as the use of first-line goal directed therapy by US patients with angina. We used individual patient level data from the National Health and Nutrition Examination Survey (NHANES), 2007-2016. Using the complex survey weights, we create projections for the US population with angina as well as those using ß-blockers, antiplatelet agents, or statins-3 first-line medications for patients with angina. Among adults ≥40 years old, 4,469,934 US adults are estimated to have physician-diagnosed angina. Of the patients with angina, 2,757,171 (61.7%) were on ß-blockers, 2,984,902 (66.8%) were on statins, and 2,433,088 (54.4%) were on any antiplatelet medication; 1,457,983 patients were on all 3 medications, for an overall proportion of 32.6% of angina patients taking all three first-line medications in the United States. While the prevalence of angina in the US is high, the use of goal-directed medical therapy remains low. Strategies to improve the use of medications for preventing secondary events are urgently needed.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Angina Estável , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Prevenção Secundária , Adulto , Angina Estável/tratamento farmacológico , Angina Estável/epidemiologia , Uso de Medicamentos/normas , Uso de Medicamentos/estatística & dados numéricos , Feminino , Mau Uso de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Inquéritos Nutricionais/estatística & dados numéricos , Prevalência , Prevenção Secundária/métodos , Prevenção Secundária/normas , Estados Unidos/epidemiologia
12.
Cochrane Database Syst Rev ; 7: CD007037, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-32700759

RESUMO

BACKGROUND: Beta-blockers are an essential part of standard therapy in adult congestive heart failure and therefore, are expected to be beneficial in children. However, congestive heart failure in children differs from that in adults in terms of characteristics, aetiology, and drug clearance. Therefore, paediatric needs must be specifically investigated. This is an update of a Cochrane review previously published in 2009. OBJECTIVES: To assess the effect of beta-adrenoceptor-blockers (beta-blockers) in children with congestive heart failure. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and LILACS up to November 2015. Bibliographies of identified studies were checked. No language restrictions were applied. SELECTION CRITERIA: Randomised, controlled, clinical trials investigating the effect of beta-blocker therapy on paediatric congestive heart failure. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted and assessed data from the included trials. MAIN RESULTS: We identified four new studies for the review update; the review now includes seven studies with 420 participants. Four small studies with 20 to 30 children each, and two larger studies of 80 children each, showed an improvement of congestive heart failure with beta-blocker therapy. A larger study with 161 participants showed no evidence of benefit over placebo in a composite measure of heart failure outcomes. The included studies showed no significant difference in mortality or heart transplantation rates between the beta-blocker and control groups. No significant adverse events were reported with beta-blockers, apart from one episode of complete heart block. A meta-analysis of left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) data showed a very small improvement with beta-blockers. However, there were vast differences in the age, age range, and health of the participants (aetiology and severity of heart failure; heterogeneity of diagnoses and co-morbidities); there was a range of treatments across studies (choice of beta-blocker, dosing, duration of treatment); and a lack of standardised methods and outcome measures. Therefore, the primary outcomes could not be pooled in meta-analyses. AUTHORS' CONCLUSIONS: There is not enough evidence to support or discourage the use of beta-blockers in children with congestive heart failure, or to propose a paediatric dosing scheme. However, the sparse data available suggested that children with congestive heart failure might benefit from beta-blocker treatment. Further investigations in clearly defined populations with standardised methodology are required to establish guidelines for therapy. Pharmacokinetic investigations of beta-blockers in children are also required to provide effective dosing in future trials.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Adolescente , Carbazóis/uso terapêutico , Carvedilol , Criança , Pré-Escolar , Insuficiência Cardíaca/mortalidade , Transplante de Coração/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Metoprolol/uso terapêutico , Propanolaminas/uso terapêutico , Propranolol/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Volume Sistólico
13.
Kardiologiia ; 60(6): 30-40, 2020 Jul 07.
Artigo em Russo | MEDLINE | ID: mdl-32720613

RESUMO

Aim      To evaluate trends in beta-blocker prescribing and incidence of possible reasons for beta-blocker administration, including arterial hypertension (AH), atrial fibrillation (AF), ischemic heart disease (IHD), and myocardial infarction, in participants of clinical studies enrolling patients with chronic heart failure with preserved ejection fraction (CHF-PEF).Material and methods  A systematic literature search was performed in the PubMed and EMBASE databases. The study included RCSs of pharmacological therapies for patients with CHF-PEF conducted from 1993 through 2019. Studies of beta-blocker efficacy or those including a specific population (CHF-PEF+IHD or CHF-PEF+AH, etc.) were excluded from the analysis. Baseline characteristics of patients, incidence rate of beta-blocker prescribing, and prevalence of AH, AF, IHD, and MI were recorded. Trends in prevalence of concomitant diseases and the proportion of patients using beta-blockers by the year of enrollment to the study were analyzed with the Mann-Kendall test.Results 14 RCSs of 718 selected publications completely met the inclusion and exclusion criteria. Beta-blocker prescribing significantly increased between 1993 and 2019 (tau=0.51; p=0.014) and reached 80 % in recent studies. Furthermore, prevalence of IHD, MI, AH, and AF did not significantly change among the RCS participants (p>0.05 for all). However, while for AH and AF, a tendency toward an increasing prevalence (tau=0.4; p=0.055 and tau=0.043; p=0.063, respectively) could be considered and became statistically significant for AF when the ALDO-DHF study was excluded from the analysis (tau=0.5; p=0.042), the MI prevalence tended to decrease (tau= -0.73; p=0.06).Conclusion      Beta-blocker prescribing to patients upon inclusion into RCSs for CHF-PEF has significantly increased for the recent 20 years while the incidence of formal reasons for beta-blocker administration (AF, AH, MI, IHD) did not significantly change.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Fibrilação Atrial , Humanos , Hipertensão , Volume Sistólico
14.
Am J Cardiol ; 128: 101-106, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650901

RESUMO

The Marfan syndrome (MFS) patients are highly predisposed to thoracic aortic aneurysm and/or dissection, with virtually every patient having evidence of aortic disease at some point during their lifetime. We conducted a meta-analysis to investigate the efficacy of angiotensin receptor blockers (ARBs) in slowing down the progression of aortic dilatation in MFS patients. PUBMED, EMBASE, and COCHRANE databases were searched for relevant articles published from inception to February 1, 2020. We included randomized clinical trials evaluating the effect of ARBs on aortic root size in patients with MFS with a follow-up period of at least 2.5 years. Seven studies were included with a total of 1,510 patients. Our analysis demonstrated a significantly smaller change in aortic root and ascending aorta dilation in the ARBs treated group when compared with placebo (mean difference 0.68; 95% confidence interval [CI] -1.31 to -0.04; p = 0.04, I2 = 94%, and mean difference -0.13, 95% CI -0.17 to -0.09; p < 0.00001, I2 = 0%, respectively). ARBs as an add-on therapy to beta-blockers resulted in a significantly smaller change in aortic root dilation when compared with the arm without ARBs (mean difference -2.06, 95% CI -2.54 to -1.58; p < 0.00001, I2 = 91%). However, there was no statistically significant difference in the number of clinical events (aortic complications/surgery) observed in the ARBs arm when compared with placebo (Risk ratio of 1.01, 95% CI 0.74 to 1.38; p = 0.94, I2 = 0%). In conclusion, ARBs therapy is associated with a slower progression of aortic root dilation when compared with placebo and as an addition to beta-blocker therapy.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Doenças da Aorta/prevenção & controle , Síndrome de Marfan/tratamento farmacológico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/prevenção & controle , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/etiologia , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/etiologia , Dilatação Patológica/prevenção & controle , Progressão da Doença , Quimioterapia Combinada , Ecocardiografia , Humanos , Irbesartana/uso terapêutico , Losartan/uso terapêutico , Imagem por Ressonância Magnética , Síndrome de Marfan/complicações
15.
Am J Cardiol ; 128: 120-126, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650905

RESUMO

Women and patients with incomplete revascularization (IR) have a worse prognosis after ST elevation myocardial infarction (STEMI). However, the extent to which IR affects outcomes for women with STEMI compared with men is not well characterized. Thus, we examined late outcomes of 589 consecutive STEMI patients who received percutaneous coronary intervention and assessed SYNTAX scores (SS), both at baseline and after all procedures (residual SS). A residual SS >8 defined IR. The primary end point was cardiac death or myocardial infarction (MI), with median follow-up of 3.6 years [interquartile range [IQR] 2.6 to 4.7]. Women (n = 123) had lower baseline SSs 15.0 [IQR 9 to 20], than men (n = 466), 16.0 [IQR 9 to 20; p = 0.02. After all planned procedures, the residual SS was 5.0 [IQR 0 to 9] in women and 5.0 (IQR 1 to 11] in men, p = 0.37. Cardiac death or MI occurred in (97/589) patients (16%), 24% (30/123) in women and 14% (67/466) in men (hazard ratio [HR] 1.75; 95% confidence intervals [CI] 1.14 to 2.69; p = 0.01). In patients with residual SYNTAX score (rSS) >8 cardiac death or MI occurred in 43% (15/35) of women and 23% 36/158 men (HR 2.14; 95% CI 1.17 to 3.91; p = 0.01). In patients with rSS = 0 to 8 cardiac death or MI occurred in 17% (15/88) of women and 10% of men (31/308) (HR 1.68; 95% CI 0.91 to 3.12; p = 0.10; interaction p value 0.58). Multivariate analysis found women were 1.77 times more likely than men to experience cardiac death or MI (95% CI 1.13 to 2.77; p = 0.01). In conclusion, we found despite a lower burden of disease at presentation and no difference in rates of IR between men and women, outcome differences were substantial. Women with rSS >8 were twice as likely as men with the same rSS to experience cardiac death or MI post-STEMI. Differences remained significant postrisk adjustment.


Assuntos
Cardiopatias/mortalidade , Infarto do Miocárdio/epidemiologia , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Terapia Trombolítica , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Antitrombinas/uso terapêutico , Feminino , Seguimentos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Modelos de Riscos Proporcionais , Recidiva , Fatores Sexuais , Stents , Resultado do Tratamento
16.
Am J Cardiol ; 128: 75-83, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650928

RESUMO

Highly reliable identification of adults with hypertrophic cardiomyopathy (HC) at risk for sudden death (SD) has been reported. A significant controversy remains, however, regarding the most reliable risk stratification methodology for children and adolescents with HC. The present study assesses the accuracy of SD prediction and prevention with prophylactic implantable cardioverter-defibrillators (ICDs) in young HC patients. The study group is comprised of 146 HC patients <20 years of age evaluated consecutively over 17 years with prospective risk stratification and ICD decision-making. We relied on ≥1 established individual risk markers considered major within each patient's clinical profile, based on an enhanced American College of Cardiology /American Heart Association (ACC/AHA) guidelines algorithm. Of the 60 largely asymptomatic patients implanted with primary prevention ICDs at age 15 ± 4 years, 9 (15%) experienced device therapy terminating potentially lethal ventricular tachyarrhythmias and restoring sinus rhythm at 19 ± 6 years (range 9 to 29), 5.1 ± 6.0 years after implant; 3 patients had multiple appropriate ICD discharges. The individual risk marker algorithm was associated with 100% sensitivity in predicting SD events (95%CI: 69, 100) and 63% specificity for identifying patients without events (95%CI: 54, 71). Of these patients with device therapy, massive left ventricular hypertrophy (absolute wall thickness ≥30 mm) was the most common predictor, present in 70% of patients either alone or in combination with other risk markers. Each of the 146 study patients have survived to date at 22 ± 5 years, including all 86 without ICD recommendations. In conclusion, an enhanced ACC/AHA risk stratification strategy, based on established individual risk markers, was highly reliable in prospectively predicting SD events in children and adolescents with HC, and preventing arrhythmia-based catastrophes in this susceptible high risk population.


Assuntos
Cardiomiopatia Hipertrófica/terapia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Adolescente , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Antiarrítmicos/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Dispositivos de Terapia de Ressincronização Cardíaca , Cardiomiopatia Hipertrófica/complicações , Criança , Morte Súbita Cardíaca/etiologia , Disopiramida/uso terapêutico , Feminino , Humanos , Masculino , Prevenção Primária , Medição de Risco , Síncope/epidemiologia , Taquicardia Ventricular/epidemiologia , Adulto Jovem
17.
BMJ ; 369: m1731, 2020 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-32522811

RESUMO

OBJECTIVE: To test a scalable health system intervention to improve long term adherence to secondary prevention treatments among patients who have had a recent myocardial infarction. DESIGN: Three arm, pragmatic randomised controlled trial with blinded outcome assessment. SETTING: Nine cardiac centres in Ontario, Canada. PARTICIPANTS: 2632 patients with obstructive coronary artery disease after a myocardial infarction, identified from a centralised cardiac registry. INTERVENTIONS: Participants were randomised 1:1:1 to receive usual care, five mail-outs developed through a user centred design process, or mail-outs plus phone calls. The phone calls were delivered first by an interactive automated system to screen for non-adherence to treatment. Trained lay health workers followed up as necessary. Interventions were coordinated centrally but delivered from each patient's hospital site. MAIN OUTCOME MEASURES: Co-primary outcomes were completion of cardiac rehabilitation and adherence to recommended medication. Data were collected by blinded assessors through patient report and from administrative health databases at 12 months. RESULTS: 2632 patients (mean age 66, 71% male) were randomised: 878 to the full intervention (mail plus phone calls), 878 to mail only, and 876 to usual care. Of the respondents, 174 (27%) of 643 in the usual care group, 200 (32%) of 628 in the mail only group, and 196 (37%) of 531 allocated to the full intervention completed cardiac rehabilitation (adjusted odds ratio 1.55, 95% confidence interval 1.18 to 2.03). In the mail plus phone group, 11.7%, 6.0%, 14.4%, 32.9%, and 35.0% reported adherence to 0, 1, 2, 3, and 4 drug classes after one year, respectively, in comparison with 12.5%, 6.8%, 13.6%, 30.2%, and 36.8% in the mail only group, and 12.2%, 8.4%, 13.1%, 30.3%, and 36.1% in the usual care group, respectively (mail only v usual care, odds ratio 0.98, 95% confidence interval 0.81 to 1.19; full intervention v usual care, 0.99, 0.82 to 1.20). CONCLUSIONS: Scalable interventions delivered by mail plus phone can increase completion of cardiac rehabilitation after myocardial infarction but not adherence to medication. More intensive interventions should be tested to improve adherence to medication and to evaluate the association between attendance at cardiac rehabilitation and adherence to medication. TRIAL REGISTRATION: ClinicalTrials.gov NCT02382731, registered 9 March 2015 before any patient enrolment.


Assuntos
Reabilitação Cardíaca/estatística & dados numéricos , Doença da Artéria Coronariana/terapia , Adesão à Medicação/estatística & dados numéricos , Infarto do Miocárdio/prevenção & controle , Prevenção Secundária/estatística & dados numéricos , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Doença da Artéria Coronariana/complicações , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/reabilitação , Ontário , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Educação de Pacientes como Assunto , Inibidores da Agregação de Plaquetas/uso terapêutico , Serviços Postais , Qualidade de Vida , Sistemas de Alerta , Prevenção Secundária/métodos , Telefone , Fatores de Tempo , Resultado do Tratamento
18.
Clin Exp Hypertens ; 42(8): 707-713, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-32543272

RESUMO

PURPOSE: An elevation in blood pressure (BP) during exercise is the normal physiological response, however an abnormally exaggerated rise in BP, in terms of hypertensive response to exercise (HRE), is seen as a prognostic factor for end-organ damage and mortality. HRE is more common in hypertensive (HT) patients and data are lacking on the effect of antihypertensive medication on HRE. In this study, we evaluated patients who underwent treadmill exercise testing (TET) to reveal the effect of antihypertensive medication on HRE. MATERIALS AND METHODS: A cohort of 2970 individuals underwent TET and data were evaluated for HRE development. HRE has been defined as a systolic BP>210 mmHg in males and >190 mmHg in females throughout the TET. To reveal the effects of antihypertensive medication on HRE, 992 HT patients were analyzed. RESULTS: HRE was observed in 11.4% (n = 113) of HT patients and 5.9% (n = 107) of non-HT individuals(p < .001). HRE was observed significantly more in males (57.6% vs. 67.3%;p = .033), and in patients with higher body mass index BMI (29.1 ± 4.5 vs. 30.3 ± 5.2;0.033). There was no significant association between medication and HRE development apart from beta-blockers. Also, gender (odds ratio:1.787; 95%CI:1.160-2.751;p = .008), BMI (odds ratio:1.070;95%CI:1.025-1.116;p = .002) and being under beta-blocker treatment (odds ratio:0.637;95%CI:0.428-0.949;p = .026) were found to be independent predictors of HRE in multivariate logistic regression analysis. CONCLUSION: HRE was associated with gender, BMI and beta-blocker use in hypertensive with male gender and higher BMI associated with higher HRE, while beta-blocker-based treatment, either mono- or combination therapy, associated with lower HRE.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Exercício Físico , Hipertensão/fisiopatologia , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Exercício Físico/fisiologia , Teste de Esforço , Terapia por Exercício , Feminino , Humanos , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Razão de Chances
19.
Cardiovasc Ther ; 2020: 2509875, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32565908

RESUMO

Introduction: Beta-blocker use evaluation is a performance method that focuses on the evaluation of beta-blocker use processes to achieve optimal patient outcomes. Several studies conducted in different hospitals revealed a high incidence of inappropriate prescription of beta-blockers among hospitalized patients. Therefore, it is important to identify inappropriate beta-blocker prescribing since they may increase the risk of hospitalizations. Despite this, there was no study conducted related to drug use evaluation of beta-blockers in Nedjo general hospital (NGH). Thus, this study was aimed at assessing the use evaluation of beta-blockers in medical wards of NGH. Methods: A retrospective cross-sectional study was conducted at medical wards of NGH from January 1, 2016, to December 31, 2017. Results: Out of the total of 149 medical record of patients that contains beta-blockers, 84 (56.37%) were males and about one-third (31.54%) of the patients ages were between 41 and 50 years. Propranolol was the most commonly prescribed beta-blocker (62.76%), and 94.56% of beta-blockers were prescribed with correct indication. There were about 51%, 46.31%, 64.43%, and 46.98% of beta-blockers prescribed with the correct dose, duration, frequency, and route of administration, respectively. Regarding the routes of administration, 70 (46.98%) of them were prescribed with the correct route. Most drugs interacting were propranolol with cimetidine 26 (68.42%), and the most frequent condition for which beta-blockers were prescribed was hypertension (32.89%). Conclusion: Overall, there was an inappropriate use of beta-blockers in terms of dosage and durations. So, prescribers of NGH should strictly adhere to the national treatment guideline when prescribing medications. Additionally, drug information centers have proved useful and effective in promoting rational drug use. Hence, it should be recommended for general use.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Hospitais Gerais/tendências , Prescrição Inadequada/tendências , Serviço de Farmácia Hospitalar/tendências , Padrões de Prática Médica/tendências , Adolescente , Antagonistas Adrenérgicos beta/efeitos adversos , Adulto , Estudos Transversais , Interações Medicamentosas , Revisão de Uso de Medicamentos/tendências , Etiópia , Feminino , Fidelidade a Diretrizes/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Adulto Jovem
20.
N Z Med J ; 133(1516): 58-71, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32525862

RESUMO

AIMS: To describe the use of evidence-based heart failure therapies in patients with reduced left ventricular ejection fraction (LVEF) following acute coronary syndrome (ACS). METHODS: Patients with ACS and LVEF ≤40% were identified from the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry between June 2017 and May 2018. Data was obtained from retrospective review of clinical records. Dispensed medications were identified from pharmacy dispensing records and compared with target doses recommended in guidelines. RESULTS: Of 292 patients, 28% were seen in cardiology heart failure (HF) clinic, 54% seen in general cardiology clinic and 17% were not seen in cardiology clinic. At one year post-discharge, 52% and 39% were dispensed ≥50% target dose of angiotensin converting enzyme inhibitor (ACEi)/ angiotensin receptor blocker (ARB), and beta-blockers respectively. Seventy-one percent and 68% of patients were on maximally tolerated doses of ACEi/ARB and beta-blockers respectively. The highest rates of medication up-titration occurred in those seen in cardiology HF clinics. Seventy-four percent and 59% were dispensed ≥50% target dose of ACEi/ARB and beta-blocker respectively. Ninety-five percent and 89% were on maximally tolerated doses of ACEi/ARB and beta-blockers respectively. Thirteen percent were potentially eligible for primary prevention implantable cardiac defibrillator; however, only 24% of these eligible patients had one implanted by one year post-discharge. CONCLUSIONS: Evidence-based HF therapies were underutilised in this regional cohort of patients with reduced LVEF post-ACS. Strategies to improve use of these therapies should focus on increasing the number of patients seen by HF clinics and reducing clinic waiting times.


Assuntos
Síndrome Coronariana Aguda/complicações , Antagonistas Adrenérgicos beta/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Desfibriladores Implantáveis , Fidelidade a Diretrizes/estatística & dados numéricos , Insuficiência Cardíaca/tratamento farmacológico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Idoso , Medicina Baseada em Evidências , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Guias de Prática Clínica como Assunto , Sistema de Registros , Estudos Retrospectivos , Volume Sistólico
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