RESUMO
Chronic Chagas cardiomyopathy (CCC) has unique pathogenic and clinical features with worse prognosis than other causes of heart failure (HF), despite the fact that patients with CCC are often younger and have fewer comorbidities. Patients with CCC were not adequately represented in any of the landmark HF studies that support current treatment guidelines. PARACHUTE-HF (Prevention And Reduction of Adverse outcomes in Chagasic Heart failUre Trial Evaluation) is an active-controlled, randomized, phase IV trial designed to evaluate the effect of sacubitril/valsartan 200 mg twice daily vs enalapril 10 mg twice daily added to standard of care treatment for HF. The study aims to enroll approximately 900 patients with CCC and reduced ejection fraction at around 100 sites in Latin America. The primary outcome is a hierarchical composite of time from randomization to cardiovascular death, first HF hospitalization, or relative change from baseline to week 12 in NT-proBNP levels. PARACHUTE-HF will provide new data on the treatment of this high-risk population. (Efficacy and Safety of Sacubitril/Valsartan Compared With Enalapril on Morbidity, Mortality, and NT-proBNP Change in Patients With CCC [PARACHUTE-HF]; NCT04023227).
Assuntos
Aminobutiratos , Antagonistas de Receptores de Angiotensina , Compostos de Bifenilo , Cardiomiopatia Chagásica , Combinação de Medicamentos , Enalapril , Insuficiência Cardíaca , Tetrazóis , Valsartana , Humanos , Compostos de Bifenilo/uso terapêutico , Aminobutiratos/uso terapêutico , Enalapril/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Cardiomiopatia Chagásica/tratamento farmacológico , Insuficiência Cardíaca/tratamento farmacológico , Tetrazóis/uso terapêutico , Volume Sistólico/fisiologia , Fragmentos de Peptídeos/sangue , Doença Crônica , Peptídeo Natriurético Encefálico/sangue , Masculino , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Feminino , Resultado do TratamentoRESUMO
BACKGROUND: To characterize the use of sacubitril/valsartan in a group of patients with heart failure in Colombia. RESEARCH DESIGN AND METHODS: Follow-up study of patients with heart failure who started sacubitril/valsartan and were affiliated with the Colombian health system between 2019 and 2021. Sociodemographic, clinical, and pharmacological variables and adherence and persistence of use were identified. RESULTS: A total of 514 patients were identified, with a mean age of 65.7 years, 73.7% of whom started sacubitril/valsartan at low doses, and only 12.5% reached the maximum dose. Adherence was 78.2% and persistence was 56.8% at 1 year of follow-up. The increase in systolic blood pressure (odds ratio (OR): 1.01; 95% CI: 1.00-1.03) and the use of ß-blockers (OR: 2.63; 95% CI: 1.42-4.85) were correlated with a greater persistence, while receiving furosemide (OR: 0.59; 95% CI: 0.39-0.89) and not having received renin - angiotensin - aldosterone system inhibitors in the 3 months before starting sacubitril/valsartan (OR: 0.48; 95% CI: 0.31-0.76) were associated with lower persistence. CONCLUSIONS: The persistence of treatment 1 year after starting sacubitril/valsartan was not high, and a small proportion of patients reached the target dose of the drug. Nontitration of the drug dose was common.
Assuntos
Insuficiência Cardíaca , Tetrazóis , Humanos , Idoso , Seguimentos , Tetrazóis/uso terapêutico , Volume Sistólico/fisiologia , Antagonistas de Receptores de Angiotensina/uso terapêutico , Resultado do Tratamento , Valsartana/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Aminobutiratos/uso terapêutico , Compostos de Bifenilo/uso terapêutico , Combinação de MedicamentosRESUMO
BACKGROUND: Heart failure (HF) management has markedly improved, but a clinically meaningful improvement in functional capacity and quality of life is perhaps more important for patients than living longer. OBJECTIVE: This study aimed to review the improvement in quality of life with sacubitril/valsartan in patients with HF and reduced/preserved ejection fraction (EF) from prospective clinical trials. METHODS: PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) and prospective cohort studies published from inception to July 2021. A total of 6 clinical trials and 16854 patients with HF were included. The primary outcome was the change from baseline in KCCQ clinical summary score. The secondary outcomes were scores in other domains of KCCQ, the occurrence of serious adverse events (AEs), and overall mortality. P-values <0.05 were considered statistically significant. RESULTS: Treatment of sacubitril/valsartan showed significantly higher KCCQ-CSS compared to the control (WMD=0.975, 95% CI: 0.885, 1.064, p<0.001; I2=94.8%, pheterogeneity<0.001). A significant decrease in the mortality rate was observed in the sacubitril/valsartan group compared to the control group (RR=0.895, 95%CI:0.831, 0.965, p=0.004; I2=43.6%, pheterogeneity=0.150). Nevertheless, no significant reduction in the occurrence of serious AEs was found among HF patients treated with sacubitril/valsartan compared to the control group (RR=0.950, 95%CI: 0.879, 1.027, p<0.001; I2=68.1%, pheterogeneity=0.024). CONCLUSIONS: Our study demonstrated that sacubitril/valsartan might significantly improve the HRQL compared to other treatments according to the results in KCCQ-CSS and some subdomains in the KCCQ index during the follow-up in patients with HF.
FUNDAMENTO: O manejo da insuficiência cardíaca (IC) tem melhorado acentuadamente, mas uma melhora clinicamente significativa na capacidade funcional e na qualidade de vida talvez seja mais importante para os pacientes do que viver mais. OBJETIVO: Este estudo teve como objetivo revisar a melhora na qualidade de vida com sacubitril/valsartan em pacientes com IC e fração de ejeção (FE) reduzida/preservada a partir de ensaios clínicos prospectivos. MÉTODOS: PubMed, Embase e Cochrane Library foram pesquisados em busca de ensaios clínicos randomizados (ECRs) e estudos de coorte prospectivos publicados desde o início até julho de 2021. Um total de 6 ensaios clínicos e 16.854 pacientes com IC foram incluídos. O desfecho primário foi a alteração da linha de base na pontuação do resumo clínico do KCCQ. Os desfechos secundários foram pontuações em outros domínios do KCCQ, ocorrência de eventos adversos graves (EAs) e mortalidade geral. Valores de p < 0,05 foram considerados estatisticamente significativos. RESULTADOS: O tratamento de sacubitril/valsartan mostrou KCCQ-CSS significativamente maior em comparação com o controle (DMP=0,975, IC 95%:0,885, 1,064, p<0,001; I2=94,8%, pheterogeneidade<0,001). Uma diminuição significativa na taxa de mortalidade foi observada no grupo sacubitril/valsartan em comparação com o grupo controle (RR=0,895, IC 95%: 0,831, 0,965, p=0,004; I2=43,6%, pheterogeneidade=0,150). No entanto, nenhuma redução significativa na ocorrência de EAs graves foi encontrada entre pacientes com IC tratados com sacubitril/valsartan em comparação com o grupo controle (RR=0,950, IC 95%: 0,879, 1,027, p<0,001; I2=68,1%, pheterogeneidade= 0,024). CONCLUSÕES: Nosso estudo demonstrou que o sacubitril/valsartan pode melhorar significativamente a QVRS em comparação com outros tratamentos de acordo com os resultados do KCCQ-CSS e alguns subdomínios do índice KCCQ durante o acompanhamento em pacientes com IC.
Assuntos
Insuficiência Cardíaca , Tetrazóis , Humanos , Aminobutiratos/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Combinação de Medicamentos , Insuficiência Cardíaca/tratamento farmacológico , Qualidade de Vida , Volume Sistólico , Tetrazóis/uso terapêutico , Valsartana/efeitos adversos , Ensaios Clínicos como AssuntoAssuntos
Insuficiência Cardíaca , Qualidade de Vida , Humanos , Valsartana , Insuficiência Cardíaca/tratamento farmacológico , Aminobutiratos/uso terapêutico , Combinação de Medicamentos , Antagonistas de Receptores de Angiotensina/uso terapêutico , Volume Sistólico , Tetrazóis/uso terapêutico , Resultado do TratamentoRESUMO
Background: There is a lack of epidemiological data around heart failure (HF) in Latin America; the potential impact description of this disease in middle-income countries is relevant. Objective: This study aimed to describe the characteristics and healthcare resource utilization patterns of HF patients at baseline and six-month follow-up. Methods: This retrospective observational study used data from the RECOLFACA (Registro Colombiano de Falla Cardíaca) registry, which includes data obtained from the examination of clinical records from 2,528 patients in 60 Colombian healthcare institutions. Baseline and six-month follow-up data were evaluated from patients with previous hospital admissions due to HF during the 12 months prior to enrollment. Results: This study analyzed 2,045 patients (42.8% female) with a mean age of 67.71 ± 13.64 years. The most common etiologies were ischemic (44.4%) and hypertensive heart disease (38.5%). At baseline, 53.4% of patients were classified with NYHA class II, and 73.6% had a reduced left ventricle ejection fraction (LVEF). A year prior to entering the registry, patients were hospitalized an average of 1.4 ± 1.1 times due to HF. Prescription of evidence-based treatment at baseline included sacubitril/valsartan (10%), ACEI (33%), ARB (41%), beta-blocker (79%), diuretics (68%), and MRA (56%). The average quality of life score measured using the EQ-5D-3L questionnaire was 78.7 ± 20.8 at baseline and 82.3 ± 20.1 at the six-month follow-up. The mortality rate was 6.7%. Conclusions: The use of information from the RECOLFACA registry allowed characterization as well as analyses of healthcare resource utilization of patients with heart failure in Colombia. The results of this study show that multiple evidence-based treatments for HF are being widely used in Colombia, but there seems to be room for improvement regarding some interventions for the treatment of patients with HF.
Assuntos
Antagonistas de Receptores de Angiotensina , Insuficiência Cardíaca , Idoso , Idoso de 80 Anos ou mais , Aminobutiratos , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Compostos de Bifenilo , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Sistema de Registros , Volume Sistólico , Resultado do TratamentoRESUMO
AIM: The win ratio can incorporate different types of outcomes and enhance statistical power, making it a useful method for analysing composite outcomes in cardiovascular trials. The application of this approach to the PARADISE-MI trial provides an additional perspective into understanding the effects of sacubitril/valsartan in patients with acute myocardial infarction. METHODS AND RESULTS: We conducted a post-hoc analysis of the PARADISE-MI trial, which randomly assigned patients with acute myocardial infarction complicated by a reduced left ventricular ejection fraction, pulmonary congestion, or both to receive either sacubitril/valsartan (97 mg of sacubitril and 103 mg of valsartan twice daily) or ramipril (5 mg twice daily) in addition to guideline-recommended therapy. The principal composite outcome was analysed in the hierarchical order of death due to cardiovascular causes, first hospitalization for heart failure, and first outpatient episode of symptomatic heart failure. We included events confirmed by the clinical events classification (CEC) committee as well as events identified by investigators that did not meet study definitions. Results were analysed by the unmatched win-ratio method. A win ratio that exceeds 1.00 reflects a better outcome. A total of 5661 patients underwent randomization; 2830 were assigned to receive sacubitril/valsartan and 2831 to receive ramipril. The hierarchical analysis of the principal composite outcome demonstrated a larger number of wins (1 265 767 [15.7%]) than losses (1 079 502 [13.4%]) in the sacubitril/valsartan group (win ratio of 1.17, 95% confidence interval [CI] 1.03-1.33; p = 0.015). Sensitivity analyses using alternative definitions of the composite outcome showed results similar to those of the principal analysis, except for analysis restricted to events that met CEC definitions (win ratio of 1.11, 95% CI 0.96-1.30; p = 0.16). CONCLUSION: In this post-hoc analysis of the PARADISE-MI trial using the win ratio and including investigator-identified events not having CEC confirmation, sacubitril/valsartan was superior to ramipril among high-risk survivors of acute myocardial infarction.
Assuntos
Insuficiência Cardíaca , Infarto do Miocárdio , Humanos , Ramipril/uso terapêutico , Ramipril/farmacologia , Volume Sistólico , Antagonistas de Receptores de Angiotensina , Neprilisina , Tetrazóis/uso terapêutico , Função Ventricular Esquerda , Aminobutiratos/uso terapêutico , Valsartana/uso terapêutico , Compostos de Bifenilo/uso terapêutico , Combinação de Medicamentos , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/complicaçõesRESUMO
The objective of this study was to evaluate the use of diquat, glufosinate ammonium, saflufenacil and flumioxazim, positioned alone and/or combined, in the pre-harvest desiccation of soybean crops. For this purpose, a field experiment was conducted, with application of the treatments in the phenological stage R 7.2 of soybean. At 3 DAA, the herbicides diquat and their combinations with flumioxazin and ammonium glufosinate, at all doses, resulted in defoliation and desiccation percentages greater than 90%. At 5 DAA, only the flumioxazin and glufosinate ammonium treatments, alone, did not show indices for harvesting. At 10 DAA, only the control differed from the other treatments in relation to desiccation, demonstrating the need to apply desiccants to enable harvest. The results indicate that the combination of herbicides may represent an alternative to reduce doses and increase the efficacy of isolated products through synergism, in addition to operational gains.
Assuntos
Herbicidas , Paraquat , Aminobutiratos , Benzoxazinas , Dessecação , Diquat , Herbicidas/análise , Herbicidas/farmacologia , Higroscópicos , Ftalimidas , Glycine maxRESUMO
The aim of the present study was to evaluate the response in larvae of the anuran species Rhinella arenarum, Rhinella dorbignyi and Odontophrynus americanus exposed to glyphosate (GLY, 2.5 mg L-1), cypermethrin (CYP, 0.013 mg L-1), chlorpyrifos (CP, 0.1 mg L-1) and glufosinate-ammonium (GLU, 15 mg L-1) using two behavioral endpoints: mean speed (MS) and total distance moved (TD); and two enzymatic biomarkers: acetylcholinesterase (AChE) and butyrylcholinesterase (BChE). In order to assess a global response and to determine the most sensitive species, an integrated biomarker response (IBR) index was calculated. Behavioral biomarkers were tested at 1 and 60 min, and the enzymes at 60 min after exposure. The results showed that: (1) there were statistical differences between species in a series of responses in swimming behavior, and cholinesterase activities within the first-hour of exposure to CYP, GLY, and CP at environmentally relevant concentrations (ERC); (2) IBR determined that Rhinella species were the most sensitive of the species tested and (3) IBR provided a comprehensive assessment of the health status of species exposed to ERC of a wide variety of agrochemicals globally and frequently used.
Assuntos
Clorpirifos , Poluentes Químicos da Água , Acetilcolinesterase , Agroquímicos , Aminobutiratos , Animais , Anuros , Biomarcadores , Bufonidae , Butirilcolinesterase , Clorpirifos/toxicidade , Glicina/análogos & derivados , Larva , Piretrinas , GlifosatoRESUMO
Chagas cardiomyopathy is the most prevalent non-ischaemic cardiomyopathy in Latin America, with high morbidity and mortality even today. Treatment of these patients is based on the use of medications for heart failure. This study evaluated a case series of patients with Chagas heart disease who used sacubitril/valsartan at a referral hospital for this disease in Brazil. After 6 months, there was a symptomatic improvement in these individuals assessed by the New York Heart Association (NYHA) functional class, with a 44.3% reduction in the absolute number of patients classified as III-IV in the period (P = 0.035), but without changes in the parameters on the echocardiogram for reverse ventricular remodelling. There was a high mortality rate and number of hospitalizations. These results emphasize the importance of studying the use of sacubitril/valsartan in Chagas heart disease to better describe its effectiveness considering the particularities of these individuals.