IMPORTANCE Sodium glucose cotransporter 2 inhibitors reduce morbidity and mortality in patients with heart failure and reduced ejection fraction (HFrEF). Clinicians may find estimates of the projected long-term benefits of sodium glucose cotransporter 2 inhibitors a helpful addition to clinical trial results when communicating the benefits of this class of drug to patients. OBJECTIVE To estimate the projected long-term treatment effects of dapagliflozin in patients with HFrEF over the duration of a patient's lifetime.DESIGN, SETTING, AND PARTICIPANTS Exploratory analysis was performed of Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF), a phase 3 randomized, placebo-controlled clinical trial conducted at 410 sites in 20 countries. Patients with an ejection fraction less than or equal to 40% in New York Heart Association functional classification II to IV and elevated plasma levels of N-terminal pro B-type natriuretic peptide were enrolled between February 15, 2017, and August 17, 2018, with final follow-up on June 6, 2019. Mean (SD) duration of follow-up was 17.6 (5.2) months.INTERVENTIONS Dapagliflozin, 10 mg, once daily vs placebo in addition to standard therapy. MAIN OUTCOMES AND MEASURESThe primary composite outcome was time to first hospitalization for heart failure, urgent heart failure visit requiring intravenous therapy, or cardiovascular death. The trial results were extrapolated to estimate the projected long-term treatment effects of dapagliflozin over the duration of a patient's lifetime for the primary outcome and the secondary outcome of death from any cause.RESULTS A total of 4744 patients (1109 women [23.4%]; 3635 men [76.6%]) were randomized in DAPA-HF, with a mean (SD) age of 66.3 (10.9) years. The extrapolated mean event-free survival for an individual aged 65 years from a primary composite end point event was 6.2 years for placebo and 8.3 years for dapagliflozin, representing an event-free survival time gain of 2.1 years (95% CI, 0.8-3.3 years; P = .002). When considering death from any cause, mean extrapolated life expectancy for an individual aged 65 years was 9.1 years for placebo and 10.8 years for dapagliflozin, with a gain in survival of 1.7 years (95% CI, 0.1-3.3; P = .03) with dapagliflozin. Similar results were seen when extrapolated across the age range studied. In analyses of subgroups of patients in DAPA-HF, consistent benefits were seen with dapagliflozin on both event-free and overall survival. CONCLUSIONS AND RELEVANCEThese findings indicate that dapagliflozin provides clinically meaningful gains in extrapolated event-free and overall survival. These findings may be helpful in communicating the benefits of this treatment to patients with HFrEF.TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03036124
Objective: To determine whether the benefits of dapagliflozin in patients with heart failure and reduced ejection fraction (HFrEF) and type 2 diabetes in DAPA-HF varied by background glucose-lowering therapy (GLT). Research design and methods: We examined the effect of study treatment by the use or not of GLT, and by GLT classes and combinations. The primary outcome was a composite of worsening HF (hospitalization or urgent visit requiring intravenous therapy) or cardiovascular death. Results: In the 2139 type 2 diabetes patients, the effect of dapagliflozin on the primary outcome was consistent by GLT use/no use (hazard ratio 0.72 [95%CI 0.58-0.88] versus 0.86 [0.60-1.23]; P-interaction=0.39) and across GLT classes. Conclusions: In DAPA-HF, dapagliflozin improved outcomes irrespective of use/no use of GLT or by GLT type used in patients with type 2 diabetes and HFrEF.
Objective To analyze the register of patients with acute coronary syndrome (ACS) at the clinical cardiological dispensary from september to november 2018–2019 and 2020 during COVID-19. Materials and methods A retrospective study was conducted, the registry included 952 patients with ACS in 2018 and 1033 patients in 2019, as well as 964 patients in 2020 during the COVID-19 pandemic. Statistical analysis of the material was performed using the Statistica 11.0 software. Results When analyzing the provision of specialized care to patients with ACS in 2018, the average age of patients was 67 years, the mortality rate was 3.94%. The structure of ACS in 2018 was dominated by patients with ST-segment elevation myocardial infarction (STEMI) - 47%, myocardial infarction without ST-segment elevation (STEMI) occurred in 23%. The proportion of patients with unstable angina pectoris (NS) was 30%. Only 43.6% were registered with coronary heart disease (CHD) before ACS. 12.5% had a history of diabetes mellitus (DM), 31.2% had arterial hypertension (AH). This cardiovascular event recurred in 4% of patients. Average bed-days 9.73. In 2019, the average age of patients was 68 years, the mortality rate was 4.35%. In the structure of ACS in 2019, patients with STEMI were more common 47.5% than with STEMI 28%. The proportion of patients with HC was 24.5%. 52.1% of patients were registered at the dispensary before ACS with a diagnosis of coronary artery disease. A history of diabetes mellitus was in 13.0%, AH in 39.6% of patients. For 3.8% of patients, myocardial infarction in 2019 became recurrent. The average bed-days was 9.92. In 2020, the average age of patients was 66 years, the mortality rate was 6.25%. The structure of patients was dominated by patients with STEMI - 50.5%, STEMI was less common - in 17.5%. The proportion of patients with unstable angina pectoris was 32%. It was revealed that 54.4% were registered in the dispensary before ACS with coronary artery disease. 28.5% had a history of diabetes mellitus, 40.8% - AH. This event was repeated for 4.7% of patients. Average rate, bed-days rate is 8.85. Conclusions Initial analysis reveals that the group of patients with ACS in 2020 was younger than the group of patients in 2019–2020. ACS in combination with diabetes during the pandemic occurred 2 times more often than in the same period of 2018–2019. The proportion of patients registered with the dispensary increased over the period 2018–2019–2020, however, the mortality rate in the 2020 group had a clear upward trend, which may be due to various reasons, incl. the COVID-19 pandemic. The average number of bed-days also objectively decreased when comparing the 2020 and 2019–2018 patient cohorts, which may be due to the burden on the healthcare system during the pandemic. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Clinical Cardiology Dispensary
Background and purpose: Trust is embedded into the national culture. It is a tool that helps create strategic partnerships and facilitates deals that carry certain risks. Cultural differences and norms can affect business relations, but more often focus is on the obvious differences. Although trust in a business partner may be due to non-obvious differences, for example, which part of the deal the partner wants to control himself and which part of the deal he wants to give to the partner to control. If the difference between the real and desired levels of the partner’s control over the deal is large, then is trust possible, especially in intercultural business relations?Objective: One aim of our study is to find out whether trust may be considered as moderator of control in a business deal. In other words, if the level of trust in a business partner is higher, are the partners more open to sharing their control over the deal with each other? The other aim is to identify the links between these indicators (trust and control) in business partnerships of partners from different cultures.Design/Methodology/Approach: The study investigated the answers of 103 Slovenian and 124 Russian business partners. The Organizational Trust Inventory (OTI) and the 5-items questionnaire on control over deal were used to collect data. Descriptive and inferential statistics were used to process the data collected.Results: The probability that the business partner will not fulfil their obligations in the deal negatively relates to the level of trust. The difference between degree of desired control and degree of control negatively relates to the level of trust.Conclusion: As our results showed, trust cannot be considered as a strong moderator of control between partners. In response to greater trust, the respondents only agree to increase their partner’s control, but are not willing to reduce their own. Moreover, this finding is stronger in the group of Russian partners than in the Slovenian ones.
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