REC: CardioClinics最新文献

Introduction y objectives

Cardiovascular complications of coronavirus disease 2019 (COVID-19) include various arrhythmias, particularly atrial fibrillation (AF), which has been linked as a risk factor for adverse events, impacting mortality during active infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). No studies have investigated this in the Latin American population; thus, we evaluated the impact of a history of AF on intrahospital morbidity and mortality in COVID-19 patients.

Methods

A multicenter, retrospective observational analysis was conducted based on the Latin American CARDIO COVID 19-20registry, including COVID-19 patients from 14 Latin American countries.

Results

Of the 3260 SARS-CoV-2-positive patients, 3.5% had a history of AF. This group had a higher prevalence of hypertension (70.4% vs 48.2%; P<.001), heart failure (43.4% vs 4.2%; P<.001), and dyslipidemia (30.4% vs 13.2%; P<.001) than those without AF. Additionally, they had higher values of troponin I (0.03 vs 0.01; P<.001) and NT-proBNP (3045 vs 341.1; P < .001). Cardiovascular complications, such as decompensated heart failure (39.1% vs 7.4%; P<.001) and arrhythmias (40.9% vs 7.9%; P<.001), and in-hospital mortality were more prevalent in the AF group (40.0% vs 25.5%; P<.001).

Conclusions

In Latin America, COVID-19 patients with a history of AF had higher values of cardiac damage biomarkers, more cardiovascular complications, and higher in-hospital mortality.

As a result of the demographic change, with an increase in chronicity, new forms of health care between primary care and cardiology have been necessary. These e-consultations are intended to improve accessibility to hospital care, with a reduction in delay times and telematic resolution without a face-to-face visit, which may result in clinical benefits in terms of reduced hospitalizations and emergency visits. However, this model is not universally available, nor is the organization homogeneous between the different healthcare areas. In this consensus document of the SAC, SAMFYC, SEMERGEN Andalusia, and SEMG Andalusia, we develop the main guidelines on the use of e-consultation between cardiology and primary care: (a) necessary requirements for adequate communication via e-consultation; (b) reasons for consultation or care processes offered; (c) need for clinical information provided by primary care; (d) type of e-consultation responses; and (e) time required for care.

Introduction and objectives

To estimate the prevalence of patients with established cardiovascular disease (CVD) and type 2 diabetes mellitus (DM2) who are overtreated.

Methods

Cross-sectional study, which included a consecutive sample of adults, with CVD (defined as a history of acute myocardial infarction, cerebrovascular accident and/or peripheral arterial disease) and DM2, active affiliates to institutional prepaid of a high complexity hospital in Argentina. Overtreatment was defined as those who had at least one glycosylated hemoglobin (HbA1c) value <7% in the last year and had been prescribed at least one drug with a high risk of hypoglycemia (insulin and/or sulfonylureas and/or glinides) as part of their therapeutic scheme.

Results

A total of 1153 persons with established CVD and DM2 were included, 68.08% male, with a mean age of 75.38 years (SD = 10.07), 89.59% had arterial hypertension, 52.82% were active smokers, and the average body mass index was 29.80 kg/m² (SD = 5.03). As established CVD, 63.23% had a history of coronary disease, 38.86% of stroke, and 13.44% of peripheral vascular disease. The prevalence of overtreatment was 13.87% (95%CI: 11.93-16.01). Among the 160 overtreated patients, 88.13% were prescribed insulin, 12.5% sulfonylureas, and 4.38% glinides.

Conclusions

The prevalence of overtreatment among individuals with CVD and DM2 (14%) is comparatively lower than the rates reported in other studies. However, the clinical implications of these findings remain significant: the potential escalation of adverse side effects, such as hypoglycemia; the subsequent elevation in healthcare expenses due to superfluous treatments; and the possible strain on the healthcare system's capabilities, including the diversion of crucial medical resources —such as physician hours, essential equipment, and hospital beds— from those who are genuinely in need.

Introduction and objectives

Amyloidosis is a rare disease. Advances in understanding and diagnosis have increased detection of the disease. Our objective was to describe the evolution in the distribution of amyloidosis subtypes, the clinical characteristics and diagnostic methods used in an Institutional Registry of Amyloidosis in Argentina over 18 years.

Methods

Consecutive patients with AL amyloidosis, ATTR wild type, ATTR variant, and AA between 1 January 2005 and 31 December 2022 were included. The evolution in the distribution of subtypes, clinical characteristics and diagnostic modalities was analyzed in three subperiods: 2005-2010; 2011-2016; 2017-2022.

Results

A total of 258 patients were included. The distribution of amyloidosis subtypes varied throughout the study period. AL amyloidosis was the most frequent in the first subperiods (85% and 63% respectively), while ATTR wild type amyloidosis predominated in the last subperiod (49%) (P < .001). The age at diagnosis increased from 60 years [interquartile range (IIC): 52-69] between 2005-2010 to 76 years [IIC: 66-83] between 2017-2022 (P < .001). Heart failure was common in all subperiods, with an increase in the last one. The history of carpal tunnel was observed more in the last subperiod.

Conclusions

In this study we observed an increase in the detection of cases of systemic amyloidosis and ATTR wild type in particular. In addition, a transition towards non-invasive diagnostic methods was evidenced, such as DPD scintigraphy, reflecting technological advances in disease detection.

Heart failure (HF) is considered a public health problem that affects a significant proportion of the population, especially older adults, leading to substantial morbidity, mortality, and high healthcare costs. Therefore, it becomes necessary to adopt prevention strategies from initial medical care and follow-up as a primary healthcare measure. With the aging population, the increase in cardiovascular risk factors in the general population, a higher survival rate after cardiovascular ischemic events, and an increase in life expectancy, the prevalence and incidence of HF is expected to rise in the upcoming years. The development of symptomatic heart failure is associated with a worsening prognosis despite treatment in accordance with current guidelines, making it a significant source of healthcare resource consumption. Hence, it is relevant to discuss the levels of HF prevention through interventions on risk factors, the disease's progression in those in the early stages of HF, as well as in those in the established and advanced stages of the disease to understand the impact of preventive measures on prognosis when implemented at different stages of the disease.