Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 26.041
Filtrar
1.
N Z Med J ; 134(1538): 77-88, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239147

RESUMO

AIMS: Heart failure with reduced ejection fraction (HFrEF) is associated with poor outcomes. While several medications are beneficial, achieving optimal guideline-directed medical therapy (GDMT) is challenging. COVID-19 created a need to explore new ways to deliver care. METHODS: Fifty consecutive patients were taught to identify fluid congestion and monitor their vital signs using BP monitors and electronic scales with NP-led telephone support. Quantitative data were collected and a patient experience interview was performed. RESULTS: The majority (76%) of the cohort (male, 76%; Maori/Pacific, 58%) had a new diagnosis of HFrEF, with 90% having severe left ventricular (LV) dysfunction. There were 216 contacts (129 (60%) by telephone), which eliminated travelling, (time saved, 2.12 hours per patient), petrol costs ($58.17 per patient), traffic pollution (607 Kg of CO2) and time off work. Most (75%) received contact within two weeks and 75% were optimally titrated within two months. Improvements in systolic BP (SBP) (124mmHg to 116mmHg), pulse (78 bpm to 70 bpm) and N-terminal pro-brain natriuretic peptide (NT-proBNP) (292 to 65) were identified. Of the 43 patients who had a follow-up transthoracic echocardiogram (TTE), 33 (77%) showed important improvement in left ventricular ejection fraction (LVEF). CONCLUSIONS: Patients found the process acceptable and experienced rapid titration with less need for clinic review with titration rates comparable with most real-world reports.


Assuntos
COVID-19/prevenção & controle , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Profissionais de Enfermagem , Padrões de Prática em Enfermagem , Telemedicina , Idoso , Fator Natriurético Atrial/sangue , Pressão Sanguínea , Estudos de Viabilidade , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Satisfação do Paciente , Projetos Piloto , Guias de Prática Clínica como Assunto , Precursores de Proteínas/sangue , SARS-CoV-2 , Volume Sistólico , Telemedicina/economia , Telemedicina/organização & administração , Telefone , Viagem/economia
2.
Vnitr Lek ; 67(4): 212-217, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34275306

RESUMO

AIM: Treatment with sacubitril/valsartan (S/V) significantly improves cardiovascular morbidity, mortality, quality of life and prolongs the survival of chronic heart failure patients with reduced ejection fraction. The aim of the study was to evaluate changes in ejection fraction, NT-proBNP and glomerular filtration after 12 months of sacubitril/valsartan treatment. METHODS: 30 patients (28 men) with chronic heart failure with reduced ejection fraction, functional classes NYHA II-III, EF LK < 40%, NT-proBNP (> 450 ng/l), with glomerular filtration > 0.5 ml/s/1.73 m2, with a potassium < 5.4 mmol/l were classified in the study. S/V treatment was started at systolic blood pressure > 100 mmHg. Ejection fraction, glomerular filtration rate and NT-proBNP values were compared before treatment and after 12 months of S/V treatment. The number of hospitalizations and deaths was also monitored. RESULTS: During 12 months of S/V treatment there was a significant improvement in left ventricular ejection fraction (median initial 26.3%, after treatment 36.3%, difference 7.5%, p.


Assuntos
Insuficiência Cardíaca , Qualidade de Vida , Aminobutiratos , Antagonistas de Receptores de Angiotensina , Biomarcadores , Compostos de Bifenilo , Combinação de Medicamentos , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Masculino , Volume Sistólico , Tetrazóis , Valsartana , Função Ventricular Esquerda
3.
Intern Med ; 60(13): 2093-2095, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34193775

RESUMO

Hyperkalemia is a challenging comorbidity to manage in patients with heart failure and chronic kidney disease, particularly when administering renin-angiotensin-aldosterone system inhibitors. We encountered an 88-year-old woman with hypertensive heart failure and chronic kidney disease. A mineralocorticoid receptor antagonist was able to be safely administered despite persistent hyperkalemia when sodium zirconium cyclosilicate, a non-absorbed, non-polymer zirconium silicate compound that preferentially exchanges hydrogen and sodium for potassium and ammonium ions in the gastrointestinal tract, was concomitantly administered. Sodium zirconium cyclosilicate might be a promising therapeutic tool to use in order to administer mineralocorticoid receptor antagonist safely in patients with heart failure, chronic kidney disease, and hyperkalemia.


Assuntos
Insuficiência Cardíaca , Hiperpotassemia , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Hiperpotassemia/tratamento farmacológico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Potássio , Sistema Renina-Angiotensina , Silicatos/uso terapêutico
4.
BMC Public Health ; 21(1): 1040, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078322

RESUMO

BACKGROUND: The risk of heart failure is disproportionately high among the socioeconomically disadvantaged. Furthermore, socioeconomically deprived patients are at risk of inequitable access to heart failure treatment and poor outcomes. Non-employment as a risk factor in this respect has not previously been studied at the level of the individual. The aim of this register-based cohort study was to analyse equity in access to renin-angiotensin system blockers and mortality, by employment status and educational level. METHODS: The study population consisted of Swedish patients aged 20-64 years hospitalised for heart failure in July 2006-December 2010, without a heart failure hospitalisation within one year or more before index hospitalisation and without renin-angiotensin system blocker dispensation in the 6 months preceding index hospitalisation. Non-access to renin-angiotensin system blockers, measured as drug dispensations, was investigated by employment status and educational level through logistic regression. Cox regression models were used to obtain hazard ratios for all-cause death by educational level and employment status. Interaction analysis was used to test whether associations between access to treatment and mortality differed by employment status. RESULTS: Among the 3874 patients, 1239 (32%) were women. The median age was 57 years. Fifty-three percent were employed. The non-employed patients had more comorbidity and lower access (68%) to renin-angiotensin system blockers compared with the employed (82%). The adjusted odds ratio for non-access to renin-angiotensin system blockers among the non-employed was 1.76. Non-employment was associated with an adjusted hazard ratio of 1.76 for death. Low educational level was associated with a higher death risk. Mortality was highest among the non-employed without access to renin-angiotensin system blockers and the association between access to renin-angiotensin system blockers and survival was slightly weaker in this group. CONCLUSIONS: Non-employment and low educational level were associated with elevated mortality in heart failure. Non-employment was a risk factor for lower access to evidence-based treatment, and among the non-employed access to treatment was associated with a slightly smaller risk reduction than among the employed. The results underscore that clinicians need to be aware of the importance of socioeconomic factors in heart failure care.


Assuntos
Inibidores da Enzima Conversora de Angiotensina , Insuficiência Cardíaca , Estudos de Coortes , Feminino , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Suécia/epidemiologia
5.
Curr Cardiol Rep ; 23(7): 91, 2021 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-34121150

RESUMO

PURPOSE OF REVIEW: As medicine strives to become more patient-centered, patient-reported outcomes (PROs) are often used to describe patients' symptoms, function, and quality of life. This review describes the key concepts of PROs specific to heart failure in clinical trials and their potential role in clinical practice. RECENT FINDINGS: As the Food and Drug Administration has increasingly emphasized how it values PROs as clinical outcome assessments, including its recent qualification of the Kansas City Cardiomyopathy Questionnaire (KCCQ), clinical trials have increasingly used them to evaluate novel therapies. This has been enhanced by an increasing understanding of how to interpret KCCQ scores. Its use in clinical practice, including the importance of providers sharing results with their patients, is just emerging. PROs provide unique insights into the benefits of treatment from patients' perspectives and while their role in clinical care is just beginning, they offer an important opportunity to improve the patient-centeredness of care.


Assuntos
Cardiomiopatias , Insuficiência Cardíaca , Nível de Saúde , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Inquéritos e Questionários
6.
Vasc Health Risk Manag ; 17: 247-254, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34079271

RESUMO

Despite the current reductionist approach providing an optimal indication for diagnosis and treatment of patients with heart failure with reduced ejection fraction (HFrEF), there are no standard pharmacological therapies for heart failure with preserved ejection fraction (HFpEF). Although in its infancy in cardiovascular diseases, the epigenetic-based therapy ("epidrugs") is capturing the interest of physician community. In fact, an increasing number of controlled clinical trials is evaluating the putative beneficial effects of: 1) direct epigenetic-oriented drugs, eg, apabetalone, and 2) repurposed drugs with a possible indirect epigenetic interference, eg, metformin, statins, sodium glucose transporter inhibitors 2 (SGLT2i), and omega 3 polyunsaturated fatty acids (PUFAs) in both HFrEF and HFpEF, separately. Apabetalone is the first and unique direct epidrug tested in cardiovascular patients to date, and the BETonMACE trial has reported a reduction in first HF hospitalization (any EF value) and cardiovascular death in patients with type 2 diabetes and recent acute coronary syndrome, suggesting a possible role in secondary prevention. Patients with HFpEF seem to benefit from supplementation to the standard therapy with statins, metformin, and SGLT2i owing to their ability in reducing mortality. In contrast, the vasodilator hydralazine, with or without isosorbide dinitrate, did not provide beneficial effects. In HFrEF, metformin and SGLT2i could reduce the risk of incident HF and mortality in affected patients whereas clinical trials based on statins provided mixed results. Furthermore, PUFAs diet supplementation was significantly associated with reduced cardiovascular risk in both HFpEF and HFrEF. Future large trials will reveal whether direct and indirect epitherapy will remain a work in progress or become a useful way to customize the therapy in the real-world management of HFpEF and HFrEF. Our goal is to discuss the recent advancement in the epitherapy as a possible way to improve personalized therapy of HF.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Reposicionamento de Medicamentos , Epigênese Genética/efeitos dos fármacos , Insuficiência Cardíaca/tratamento farmacológico , Quinazolinonas/uso terapêutico , Fármacos Cardiovasculares/efeitos adversos , Insuficiência Cardíaca/genética , Insuficiência Cardíaca/fisiopatologia , Humanos , Quinazolinonas/efeitos adversos , Resultado do Tratamento
7.
Vasc Health Risk Manag ; 17: 337-348, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34135591

RESUMO

ß-blockers are a heterogeneous class of drugs, with varying selectivity/specificity for ß1 vs ß2 receptors, intrinsic sympathomimetic activity (ISA), and vasodilatory properties (through ß2 stimulation, α receptor blockade or nitric oxide release). These drugs are indicated for the management of arterial hypertension, heart failure or ischemic heart disease (IHD; eg angina pectoris or prior myocardial infarction). Most of the benefit of ß-blockade in these conditions arises from blockade of the ß1 receptor, and, in practice, the addition of ISA appears to reduce the potential for improved clinical outcomes in people with heart failure or IHD. Aspects of the benefit/risk balance of ß-blockers remain controversial, and recent meta-analyses have shed new light on this issue. We have reviewed the current place of cardioselective ß-blockade in hypertension, IHD and heart failure, with special reference to the therapeutic profile of a highly selective ß1-adrenoceptor blocker, bisoprolol.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Hipertensão/tratamento farmacológico , Isquemia Miocárdica/tratamento farmacológico , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Antagonistas Adrenérgicos beta/efeitos adversos , Bisoprolol/uso terapêutico , Tomada de Decisão Clínica , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Medição de Risco , Fatores de Risco , Resultado do Tratamento
8.
Medicine (Baltimore) ; 100(26): e26420, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190162

RESUMO

BACKGROUND: As the last link in the chain of cardiovascular events, chronic heart failure (CHF) has high morbidity, high mortality, and poor prognosis. It is one of the main causes of death and disability worldwide. As a new drug for the treatment of chronic cardiovascular disease, dapagliflozin, the efficacy, and safety issues are still the focus of attention. Therefore, we conducted a meta-analysis to evaluate the efficacy and safety of dapagliflozin in the treatment of CHF. METHODS: According to the search strategy, regardless of publication date or language, randomized controlled trials (RCTs) of dapagliflozin for CHF will be retrieved from 8 databases. First of all, the literature was screened according to the eligibility criteria, and use the Cochrane Collaboration's tool to assess the quality of the included literature. Then, using Rev Man 5.3 and STATA 14.2 software for traditional meta-analysis. Finally, the evaluation of the quality of the evidence and the strength of the recommendations will adopt the Grading of Recommendations, Assessment, Development and Evaluation method. RESULTS: This study will evaluate the efficacy and safety of dapagliflozin for CHF, thereby providing more evidence support for clinical decision-making in CHF. CONCLUSION: Our research will provide more references for the clinical medication of patients with CHF. PROTOCOL REGISTRATION NUMBER: INPLASY202150046.


Assuntos
Compostos Benzidrílicos/farmacologia , Glucosídeos/farmacologia , Insuficiência Cardíaca/tratamento farmacológico , Doença Crônica , Humanos , Metanálise como Assunto , Projetos de Pesquisa , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia , Revisões Sistemáticas como Assunto , Resultado do Tratamento
9.
Eur Heart J ; 42(24): 2373-2383, 2021 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-34076243

RESUMO

Globally, there has been little change in mortality rates from cardiovascular (CV) diseases or cancers over the past two decades (1997-2018). This is especially true for heart failure (HF) where 5-year mortality rates remain as high as 45-55%. In the same timeframe, the proportion of drug revenue, and regulatory drug approvals for cancer drugs, far out paces those for CV drugs. In 2018, while cancer drugs made 27% of Food and Drug Administration drug approvals, only 1% of drug approvals was for a CV drug, and over this entire 20 year span, only four drugs were approved for HF in the USA. Cardiovascular trialists need to reassess the design, execution, and purpose of CV clinical trials. In the area of oncology research, trials are much smaller, follow-up is shorter, and targeted therapies are common. Cardiovascular diseases and cancer are the two most common causes of death globally, and although they differ substantially, this review evaluates whether some elements of oncology research may be applicable in the CV arena. As one of the most underserved CV diseases, the review focuses on aspects of cancer research that may be applicable to HF research with the aim of streamlining the clinical trial process and decreasing the time and cost required to bring safe, effective, treatments to patients who need them. The paper is based on discussions among clinical trialists, industry representatives, regulatory authorities, and patients, which took place at the Cardiovascular Clinical Trialists Workshop in Washington, DC, on 8 December 2019 (https://www.globalcvctforum.com/2019 (14 September 2020)).


Assuntos
Fármacos Cardiovasculares , Doenças Cardiovasculares , Insuficiência Cardíaca , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Resultado do Tratamento
10.
Open Heart ; 8(1)2021 06.
Artigo em Inglês | MEDLINE | ID: covidwho-1269804

RESUMO

BACKGROUND: Prior diagnosis of heart failure (HF) is associated with increased length of hospital stay (LOS) and mortality from COVID-19. Associations between substance use, venous thromboembolism (VTE) or peripheral arterial disease (PAD) and its effects on LOS or mortality in patients with HF hospitalised with COVID-19 remain unknown. OBJECTIVE: This study identified risk factors associated with poor in-hospital outcomes among patients with HF hospitalised with COVID-19. METHODS: Case-control study was conducted of patients with prior diagnosis of HF hospitalised with COVID-19 at an academic tertiary care centre from 1 January 2020 to 28 February 2021. Patients with HF hospitalised with COVID-19 with risk factors were compared with those without risk factors for clinical characteristics, LOS and mortality. Multivariate regression was conducted to identify multiple predictors of increased LOS and in-hospital mortality in patients with HF hospitalised with COVID-19. RESULTS: Total of 211 patients with HF were hospitalised with COVID-19. Women had longer LOS than men (9 days vs 7 days; p<0.001). Compared with patients without PAD or ischaemic stroke, patients with PAD or ischaemic stroke had longer LOS (7 days vs 9 days; p=0.012 and 7 days vs 11 days, p<0.001, respectively). Older patients (aged 65 and above) had increased in-hospital mortality compared with younger patients (adjusted OR: 1.04; 95% CI 1.00 to 1.07; p=0.036). Prior diagnosis of VTE increased mortality more than threefold in patients with HF hospitalised with COVID-19 (adjusted OR: 3.33; 95% CI 1.29 to 8.43; p=0.011). CONCLUSION: Vascular diseases increase LOS and mortality in patients with HF hospitalised with COVID-19.


Assuntos
COVID-19/mortalidade , Comorbidade/tendências , Insuficiência Cardíaca/mortalidade , Doenças Vasculares/complicações , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/virologia , Estudos de Casos e Controles , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/virologia , Hospitalização/estatística & dados numéricos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , AVC Isquêmico/complicações , AVC Isquêmico/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/complicações , Prognóstico , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2/genética , Transtornos Relacionados ao Uso de Substâncias/complicações , Tromboembolia Venosa/complicações
11.
Internist (Berl) ; 62(7): 786-795, 2021 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-34164700

RESUMO

Gliflozine (inhibitors of sodium-dependent glucose cotransporters, SGLT) are medications which were originally used in the treatment of diabetes mellitus and are assigned to the group of antidiabetics. Since November 2020 the SGLT2 inhibitor dapagliflozin has been approved for the treatment of heart failure (with reduced left ventricular function) for the first time, independent of the diabetes status. The substance empagliflozin has just received an approval for the treatment of heart failure with reduced ejection fraction from the European Medicines Agency (EMA). Therefore, different gliflozins are now available not only for the treatment of diabetes mellitus but also for the treatment of cardiac insufficiency. This article mediates fundamental knowledge on the gliflozins and provides an overview of the importance in the treatment of type 2 diabetes mellitus as well as cardioprotective and nephroprotective functions.


Assuntos
Diabetes Mellitus Tipo 2 , Insuficiência Cardíaca , Preparações Farmacêuticas , Inibidores do Transportador 2 de Sódio-Glicose , Diabetes Mellitus Tipo 2/tratamento farmacológico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/prevenção & controle , Humanos , Hipoglicemiantes , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico
12.
Ann Palliat Med ; 10(6): 6535-6555, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34154360

RESUMO

BACKGROUND: Evidence of the efficacy of Shenfu injection (SFI) in the treatment of heart failure (HF) is inconsistent. This study aimed to strictly evaluate the methodological quality, reporting quality, and evidence quality of systematic reviews (SRs) and meta-analyses (MAs) on the efficacy of SFI. METHODS: From inception to December 2020, using standardized search strategies, we searched for relevant SRs and MAs in the following seven databases: Cochrane library, Embase, PubMed, SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database. The Appraisal Tool for Systematic Reviews of Randomized and Observational Studies 2 (AMSTAR-2) and Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) tools were used to evaluate the methodological and reporting quality of SRs, respectively. The quality of results was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. If necessary, we conducted quantitative synthesis or descriptive analysis of the original data. RESULTS: There were 12 SRs/MAs involving 302 original randomized controlled trials (RCTs) and more than 22,445 participants (the total number was not mentioned in 1 study). The treatment group was classified as SFI combined with western medicine (WM), while the control group was WM alone. The methodological quality of all the literatures was very low, and the quality of reports was relatively good, with an average PRISMA score of 18.25 points. We evaluated 52 outcomes, of which 3 were moderate quality, 13 were low quality, and the rest were very low quality. Low quality evidences indicated that the clinical efficacy of SFI combined with WM for HF was better than that of WM, which can improve the quality of life and cardiac function of patients. CONCLUSIONS: It appeared that SFI was effective in the treatment of HF. Due to the low quality of methodology and reports in the literature, we cannot be sure of the results. We strongly recommend that more high-level RCTs be carried out in the future. Besides, researchers should strictly comply with the AMSTAR-2, PRISMA, and GRADE guidelines for SRs.


Assuntos
Medicamentos de Ervas Chinesas , Insuficiência Cardíaca , China , Medicamentos de Ervas Chinesas/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Relatório de Pesquisa
15.
Int J Mol Sci ; 22(11)2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34071350

RESUMO

The heart has a reduced capacity to generate sufficient energy when failing, resulting in an energy-starved condition with diminished functions. Studies have identified numerous changes in metabolic pathways in the failing heart that result in reduced oxidation of both glucose and fatty acid substrates, defects in mitochondrial functions and oxidative phosphorylation, and inefficient substrate utilization for the ATP that is produced. Recent early-phase clinical studies indicate that inhibitors of fatty acid oxidation and antioxidants that target the mitochondria may improve heart function during failure by increasing compensatory glucose oxidation. Adrenergic receptors (α1 and ß) are a key sympathetic nervous system regulator that controls cardiac function. ß-AR blockers are an established treatment for heart failure and α1A-AR agonists have potential therapeutic benefit. Besides regulating inotropy and chronotropy, α1- and ß-adrenergic receptors also regulate metabolic functions in the heart that underlie many cardiac benefits. This review will highlight recent studies that describe how adrenergic receptor-mediated metabolic pathways may be able to restore cardiac energetics to non-failing levels that may offer promising therapeutic strategies.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Terapia de Alvo Molecular/métodos , Receptores Adrenérgicos alfa 1/metabolismo , Receptores Adrenérgicos beta/metabolismo , Sistema Nervoso Simpático/efeitos dos fármacos , Animais , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/fisiopatologia , Humanos , Redes e Vias Metabólicas/efeitos dos fármacos , Oxirredução/efeitos dos fármacos , Sistema Nervoso Simpático/metabolismo , Sistema Nervoso Simpático/fisiopatologia
16.
Int J Mol Sci ; 22(11)2021 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-34070765

RESUMO

Heart failure (HF) affects up to over 20% of patients with type 2 diabetes (T2DM), even more in the elderly. Although, in T2DM, both hyperglycemia and the proinflammatory status induced by insulin resistance are crucial in cardiac function impairment, SGLT2i cardioprotective mechanisms against HF are several. In particular, these beneficial effects seem attributable to the significant reduction of intracellular sodium levels, well-known to exert a cardioprotective role in the prevention of oxidative stress and consequent cardiomyocyte death. From a molecular perspective, patients' exposure to gliflozins' treatment mimics nutrient and oxygen deprivation, with consequent autophagy stimulation. This allows to maintain the cellular homeostasis through different degradative pathways. Thus, since their introduction in the clinical practice, the hypotheses on SGLT2i mechanisms of action have changed: from simple glycosuric drugs, with consequent glucose lowering, erythropoiesis enhancing and ketogenesis stimulating, to intracellular sodium-lowering molecules. This provides their consequent cardioprotective effect, which justifies its significant reduction in CV events, especially in populations at higher risk. Finally, the updated clinical evidence of SGLT2i benefits on HF was summarized. Thus, this review aimed to analyze the cardioprotective mechanisms of sodium glucose transporter 2 inhibitors (SGLT2i) in patients with HF, as well as their clinical impact on cardiovascular events.


Assuntos
Cardiotônicos/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Insuficiência Cardíaca/tratamento farmacológico , Resistência à Insulina/genética , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Transportador 2 de Glucose-Sódio/genética , Idoso , Autofagia/efeitos dos fármacos , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/mortalidade , Diabetes Mellitus Tipo 2/patologia , Eritropoese/efeitos dos fármacos , Eritropoese/genética , Regulação da Expressão Gênica , Insuficiência Cardíaca/genética , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/patologia , Hospitalização/estatística & dados numéricos , Humanos , Sódio/metabolismo , Transportador 2 de Glucose-Sódio/metabolismo , Análise de Sobrevida
17.
Open Heart ; 8(1)2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34127532

RESUMO

BACKGROUND: Prior diagnosis of heart failure (HF) is associated with increased length of hospital stay (LOS) and mortality from COVID-19. Associations between substance use, venous thromboembolism (VTE) or peripheral arterial disease (PAD) and its effects on LOS or mortality in patients with HF hospitalised with COVID-19 remain unknown. OBJECTIVE: This study identified risk factors associated with poor in-hospital outcomes among patients with HF hospitalised with COVID-19. METHODS: Case-control study was conducted of patients with prior diagnosis of HF hospitalised with COVID-19 at an academic tertiary care centre from 1 January 2020 to 28 February 2021. Patients with HF hospitalised with COVID-19 with risk factors were compared with those without risk factors for clinical characteristics, LOS and mortality. Multivariate regression was conducted to identify multiple predictors of increased LOS and in-hospital mortality in patients with HF hospitalised with COVID-19. RESULTS: Total of 211 patients with HF were hospitalised with COVID-19. Women had longer LOS than men (9 days vs 7 days; p<0.001). Compared with patients without PAD or ischaemic stroke, patients with PAD or ischaemic stroke had longer LOS (7 days vs 9 days; p=0.012 and 7 days vs 11 days, p<0.001, respectively). Older patients (aged 65 and above) had increased in-hospital mortality compared with younger patients (adjusted OR: 1.04; 95% CI 1.00 to 1.07; p=0.036). Prior diagnosis of VTE increased mortality more than threefold in patients with HF hospitalised with COVID-19 (adjusted OR: 3.33; 95% CI 1.29 to 8.43; p=0.011). CONCLUSION: Vascular diseases increase LOS and mortality in patients with HF hospitalised with COVID-19.


Assuntos
COVID-19/mortalidade , Comorbidade/tendências , Insuficiência Cardíaca/mortalidade , Doenças Vasculares/complicações , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/virologia , Estudos de Casos e Controles , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/virologia , Hospitalização/estatística & dados numéricos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , AVC Isquêmico/complicações , AVC Isquêmico/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/complicações , Prognóstico , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2/genética , Transtornos Relacionados ao Uso de Substâncias/complicações , Tromboembolia Venosa/complicações
18.
Wiad Lek ; 74(4): 1003-1006, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34156020

RESUMO

OBJECTIVE: The aim: Of the article is to conduct a comparative evaluation of the effectiveness of torasemide and furosemide in patients with heart failure. PATIENTS AND METHODS: Materials and methods: Analysis of the existing clinical trials and meta-analyzes that combine the results of the completed studies aimed at the investigation of comparative efficacy of furosemide and torasemide in patients with heart failure (НF). CONCLUSION: Conclusions: There is enough convincing evidence to speak about the advantages of torasemide over furosemide both in terms of its pharmacological properties and taking into account the reduction of hospitalizations, functional progress and improvement in the quality of life of patients with НF. The safety profile of torasemide is more favorable, as it is associated with a reduced risk of hypokalemia compared to furosemide. The abovementioned facts favor the use of torasemide in patients with symptomatic НF, as well as the transition from furosemide to torasemide in patients with edema caused by НF, which remain uncontrolled despite receiving optimal doses of furosemide.


Assuntos
Insuficiência Cardíaca , Inibidores de Simportadores de Cloreto de Sódio e Potássio , Diuréticos/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Qualidade de Vida , Inibidores de Simportadores de Cloreto de Sódio e Potássio/uso terapêutico , Sulfonamidas/uso terapêutico , Torasemida
19.
Medicine (Baltimore) ; 100(18): e25559, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950930

RESUMO

ABSTRACT: Background: Atrial fibrillation (AF) is a type of arrhythmia that represents a severe health hazard. The current therapies for AF have achieved success in some conditions. However, because the mechanisms underlying the occurrence and development of this disease remain unclear, the current treatment for AF often does not achieve the desired outcomes. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), which exert robust effects on specific cardiovascular diseases, are widely used in the clinic. Several studies are focusing on the effect of ACEIs/ARBs on the prevention and cure of AF. Some systematic reviews have obtained different and even opposite results. An overview is required to obtain a conclusion and provide strong evidence to guide clinical work.Methods: We searched 5 databases, including MEDLINE, EMBASE, Cochrane Library, Web of Science, and CNKI (Chinese), and selected relevant reviews that passed the assessment we performed. Then, we synthesized the data for each result from the included reviews and obtained conclusions.Results: ACEIs/ARBs prevented new-onset AF and AF after heart failure. ACEIs/ARBs performed well in the prevention of secondary AF, especially postoperative AF. However, for patients suffering from hypertension and myocardial infarction, ACEIs/ARBs were not the right choices for preventing AF.Conclusions: We suggest that physicians select ACEIs/ARBs as an anti-AF therapy for patients with heart failure due to their additional benefits. Moreover, for patients who have suffered AF, ACEIs/ARBs may be a routine drug for secondary prevention.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Fibrilação Atrial/prevenção & controle , Insuficiência Cardíaca/tratamento farmacológico , Prevenção Secundária/métodos , Antagonistas de Receptores de Angiotensina/farmacologia , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Insuficiência Cardíaca/complicações , Humanos , Incidência , Ensaios Clínicos Controlados Aleatórios como Assunto , Sistema Renina-Angiotensina/efeitos dos fármacos , Revisões Sistemáticas como Assunto , Resultado do Tratamento
20.
Cochrane Database Syst Rev ; 5: CD012721, 2021 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-34022072

RESUMO

BACKGROUND: Beta-blockers and inhibitors of the renin-angiotensin-aldosterone system improve survival and reduce morbidity in people with heart failure with reduced left ventricular ejection fraction (LVEF); a review of the evidence is required to determine whether these treatments are beneficial for people with heart failure with preserved ejection fraction (HFpEF). OBJECTIVES: To assess the effects of beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor neprilysin inhibitors, and mineralocorticoid receptor antagonists in people with HFpEF. SEARCH METHODS: We updated searches of CENTRAL, MEDLINE, Embase, and one clinical trial register on 14 May 2020 to identify eligible studies, with no language or date restrictions. We checked references from trial reports and review articles for additional studies.  SELECTION CRITERIA: We included randomised controlled trials with a parallel group design, enrolling adults with HFpEF, defined by LVEF greater than 40%. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included 41 randomised controlled trials (231 reports), totalling 23,492 participants across all comparisons. The risk of bias was frequently unclear and only five studies had a low risk of bias in all domains. Beta-blockers (BBs) We included 10 studies (3087 participants) investigating BBs. Five studies used a placebo comparator and in five the comparator was usual care. The mean age of participants ranged from 30 years to 81 years. A possible reduction in cardiovascular mortality was observed (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.62 to 0.99; number needed to treat for an additional benefit (NNTB) 25; 1046 participants; three studies), however, the certainty of evidence was low. There may be little to no effect on all-cause mortality (RR 0.82, 95% CI 0.67 to 1.00; 1105 participants; four studies; low-certainty evidence). The effects on heart failure hospitalisation, hyperkalaemia, and quality of life remain uncertain. Mineralocorticoid receptor antagonists (MRAs) We included 13 studies (4459 participants) investigating MRA. Eight studies used a placebo comparator and in five the comparator was usual care. The mean age of participants ranged from 54.5 to 80 years. Pooled analysis indicated that MRA treatment probably reduces heart failure hospitalisation (RR 0.82, 95% CI 0.69 to 0.98; NNTB = 41; 3714 participants; three studies; moderate-certainty evidence). However, MRA treatment probably has little or no effect on all-cause mortality (RR 0.91, 95% CI 0.78 to 1.06; 4207 participants; five studies; moderate-certainty evidence) and cardiovascular mortality (RR 0.90, 95% CI 0.74 to 1.11; 4070 participants; three studies; moderate-certainty evidence). MRA treatment may have little or no effect on quality of life measures (mean difference (MD) 0.84, 95% CI -2.30 to 3.98; 511 participants; three studies; low-certainty evidence). MRA treatment was associated with a higher risk of hyperkalaemia (RR 2.11, 95% CI 1.77 to 2.51; number needed to treat for an additional harmful outcome (NNTH) = 11; 4291 participants; six studies; high-certainty evidence). Angiotensin-converting enzyme inhibitors (ACEIs) We included eight studies (2061 participants) investigating ACEIs. Three studies used a placebo comparator and in five the comparator was usual care. The mean age of participants ranged from 70 to 82 years. Pooled analyses with moderate-certainty evidence suggest that ACEI treatment likely has little or no effect on cardiovascular mortality (RR 0.93, 95% CI 0.61 to 1.42; 945 participants; two studies), all-cause mortality (RR 1.04, 95% CI 0.75 to 1.45; 1187 participants; five studies) and heart failure hospitalisation (RR 0.86, 95% CI 0.64 to 1.15; 1019 participants; three studies), and may result in little or no effect on the quality of life (MD -0.09, 95% CI -3.66 to 3.48; 154 participants; two studies; low-certainty evidence). The effects on hyperkalaemia remain uncertain. Angiotensin receptor blockers (ARBs) Eight studies (8755 participants) investigating ARBs were included. Five studies used a placebo comparator and in three the comparator was usual care. The mean age of participants ranged from 61 to 75 years. Pooled analyses with high certainty of evidence suggest that ARB treatment has little or no effect on cardiovascular mortality (RR 1.02, 95% 0.90 to 1.14; 7254 participants; three studies), all-cause mortality (RR 1.01, 95% CI 0.92 to 1.11; 7964 participants; four studies), heart failure hospitalisation (RR 0.92, 95% CI 0.83 to 1.02; 7254 participants; three studies), and quality of life (MD 0.41, 95% CI -0.86 to 1.67; 3117 participants; three studies). ARB was associated with a higher risk of hyperkalaemia (RR 1.88, 95% CI 1.07 to 3.33; 7148 participants; two studies; high-certainty evidence). Angiotensin receptor neprilysin inhibitors (ARNIs) Three studies (7702 participants) investigating ARNIs were included. Two studies used ARBs as the comparator and one used standardised medical therapy, based on participants' established treatments at enrolment. The mean age of participants ranged from 71 to 73 years. Results suggest that ARNIs may have little or no effect on cardiovascular mortality (RR 0.96, 95% CI 0.79 to 1.15; 4796 participants; one study; moderate-certainty evidence), all-cause mortality (RR 0.97, 95% CI 0.84 to 1.11; 7663 participants; three studies; high-certainty evidence), or quality of life (high-certainty evidence). However, ARNI treatment may result in a slight reduction in heart failure hospitalisation, compared to usual care (RR 0.89, 95% CI 0.80 to 1.00; 7362 participants; two studies; moderate-certainty evidence). ARNI treatment was associated with a reduced risk of hyperkalaemia compared with valsartan (RR 0.88, 95% CI 0.77 to 1.01; 5054 participants; two studies; moderate-certainty evidence). AUTHORS' CONCLUSIONS: There is evidence that MRA and ARNI treatment in HFpEF probably reduces heart failure hospitalisation but probably has little or no effect on cardiovascular mortality and quality of life. BB treatment may reduce the risk of cardiovascular mortality, however, further trials are needed. The current evidence for BBs, ACEIs, and ARBs is limited and does not support their use in HFpEF in the absence of an alternative indication. Although MRAs and ARNIs are probably effective at reducing the risk of heart failure hospitalisation, the treatment effect sizes are modest. There is a need for improved approaches to patient stratification to identify the subgroup of patients who are most likely to benefit from MRAs and ARNIs, as well as for an improved understanding of disease biology, and for new therapeutic approaches.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Sistema Renina-Angiotensina/efeitos dos fármacos , Volume Sistólico , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Insuficiência Cardíaca/mortalidade , Hospitalização , Humanos , Pessoa de Meia-Idade , Neprilisina/antagonistas & inibidores , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...