Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).
BackgroundHeart failure (HF) is one of the leading causes of hospitalization in adults in
Brazil. However, most of the available data is limited to unicenter registries.
The BREATHE registry is the first to include a large sample of hospitalized
patients with decompensated HF from different regions in Brazil.ObjectiveDescribe the clinical characteristics, treatment and prognosis of hospitalized
patients admitted with acute HF.MethodsObservational registry study with longitudinal follow-up. The eligibility criteria
included patients older than 18 years with a definitive diagnosis of HF, admitted
to public or private hospitals. Assessed outcomes included the causes of
decompensation, use of medications, care quality indicators, hemodynamic profile
and intrahospital events.ResultsA total of 1,263 patients (64±16 years, 60% women) were included from 51 centers
from different regions in Brazil. The most common comorbidities were hypertension
(70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had
normal left ventricular systolic function and most were admitted with a wet-warm
clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in
less than 15% of the studied cohort. Care quality indicators based on hospital
discharge recommendations were reached in less than 65% of the patients.
Intrahospital mortality affected 12.6% of all patients included.ConclusionThe BREATHE study demonstrated the high intrahospital mortality of patients
admitted with acute HF in Brazil, in addition to the low rate of prescription of
drugs based on evidence.
In the past two years we observed several changes in the diagnostic and therapeutic approach of patients with acute heart failure (acute HF), which led us to the need of performing a summary update of the II Brazilian Guidelines on Acute Heart Failure 2009.In the diagnostic evaluation, the diagnostic flowchart was simplified and the role of clinical assessment and echocardiography was enhanced. In the clinicalhemodynamic evaluation on admission, the hemodynamic echocardiography gained prominence as an aid to define this condition in patients with acute HF in the emergency room. In the prognostic evaluation, the role of biomarkers was better established and the criteria and prognostic value of the cardiorenal syndrome was better defined.The therapeutic approach flowcharts were revised, and are now simpler and more objective. Among the advances in drug therapy, the safety and importance of the maintenance or introduction of beta-blockers in the admission treatment are highlighted. Anticoagulation, according to new evidence, gained a wider range of indications. The presentation hemodynamic models of acute pulmonary edema were well established, with their different therapeutic approaches, as well as new levels of indication and evidence. In the surgical treatment of acute HF, CABG, the approach to mechanical lesions and heart transplantation were reviewed and updated.This update strengthens the II Brazilian Guidelines on Acute Heart Failure to keep it updated and refreshed. All clinical cardiologists who deal with patients with acute HF will find, in the guidelines and its summary, important tools to help them with the clinical practice for better diagnosis and treatment of their patients.
Among patients with inconclusive functional stress tests, the noninvasive assessment of CAD severity by coronary CTA has been shown to provide incremental prognostic information beyond the evaluation of traditional risk factors and coronary artery calcium score.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.