Background COVID-19 can lead to multiorgan failure. Dapagliflozin, a SGLT2 inhibitor, has significant protective benefits for the heart and kidney. We aimed to see whether this agent might provide organ protection in patients with COVID-19 by affecting processes dysregulated during acute illness.Methods DARE-19 was a randomised, double-blind, placebo-controlled trial of patients hospitalised with COVID-19 and with at least one cardiometabolic risk factor (ie, hypertension, type 2 diabetes, atherosclerotic cardiovascular disease, heart failure, and chronic kidney disease). Patients critically ill at screening were excluded. Patients were randomly assigned 1:1 to dapagliflozin (10 mg daily orally) or matched placebo for 30 days. Dual primary outcomes were assessed in the intention-to-treat population: the outcome of prevention (time to new or worsened organ dysfunction or death), and the hierarchial composite outcome of recovery (change in clinical status by day 30). Safety outcomes, in patients who received at least one study medication dose, included serious adverse events, adverse events leading to discontinuation, and adverse events of interest. This study is registered with ClinicalTrials.gov, NCT04350593.

SummaryBackground: National studies on decompensated heart failure (DHF) are key to the understanding of this condition in our midst.

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BackgroundThere is a scarcity of knowledge as to whether rates of myocardial reperfusion use and 30‐day mortality for patients with ST‐segment–elevation myocardial infarction are similar among patients using the Brazilian Public Health System (SUS) and those using the private healthcare system.Methods and ResultsA total of 707 patients were analyzed using the VICTIM (Via Crucis for the Treatment of Myocardial Infarction) register database; 589 patients from the SUS and 118 from the private network with ST‐segment–elevation myocardial infarction, who attended hospitals with the capacity to perform primary percutaneous coronary intervention (PCI) were investigated. The timeline, rates of use of PCI, and the 30‐day probability of death were investigated, comparing the SUS patients to those in the private system. The mean time between symptom onset and arrival at the PCI hospital was higher for SUS patients compared with users of the private system (25.4±36.5 versus 9.0±21 hours; P<0.001, respectively). Rates of primary PCI were low in both groups, but significantly lower for the SUS patients (45% versus 78%; P<0.001). The 30‐day mortality rate of SUS patients was 11.9% and of private patients was 5.9% (P=0.04). In the fully adjusted model, the odds ratio for 30‐day mortality for the SUS patients was higher (odds ratio, 2.96; 95% CI, 1.15–7.61; P=0.02).ConclusionsThe delay in reaching a PCI hospital was almost 3 times higher for the SUS patients. Primary PCI was underused in both groups, especially in the SUS patients. The SUS patients were more likely to die during the 30‐day follow‐up.

Nota: Estas atualizações se prestam a informar e não a substituir o julgamento clínico do médico que, em última análise, deve determinar o tratamento apropriado para seus pacientes.

Introdução: Insuficiência renal aguda (IRA) acontece com frequência em pacientes críticos, porém a significância clínica de sua ocorrência não tem sido determinada na insuficiência cardíaca descompensada (ICD). Objetivos: Estudar a ocorrência e valor prognóstico da IRA em pacientes internados por ICD e avaliar comparativamente com aqueles sem a complicação o perfil clínico-laboratorial e a mortalidade intra-hospitalar. Métodos: Estudo prospectivo em 85 pacientes internados em terapia intensiva (UTI) por ICD entre março de 2010 e fevereiro de 2011. Foi feito o diagnóstico de insuficiência cardíaca (IC) conforme critérios de Boston (escala ≥ 8) e exames complementares, e o diagnóstico de IRA utilizando a classificação AKIN. Na análise estatística, utilizaram-se teste t de Student, qui-quadrado e modelo de regressão com múlti-plas variáveis, considerando estatisticamente significativo p < 0,05. Resultados: Predominaram homens (55%), valvopatia foi a principal etiologia da IC (42,4%), e má aderência/medicação inadequada foi a principal causa de descompensação (22,4%). IRA ocorreu em 76,5% dos indivíduos (4,7% estágio 1, 32,9% estágio 2 e 38,8% estágio 3 AKIN). Havia mais pacientes com anemia (p = 0,01) e acima de 60 anos (p = 0,02) no grupo com IRA quando comparado ao controle. Todos os pacientes com disfunção renal prévia desenvolveram IRA. Em média, permaneceram internados por 7,7 dias (grupo IRA 8,8 ± 6,6 dias; grupo não IRA 4 ± 1,4 dias; p < 0,01). A mortalidade foi maior no grupo com IRA (p = 0,04), principalmente no estágio 3 (p < 0,01). Identificou-se como preditor independente de IRA o nú-mero de dias em UTI (p = 0,02). IRA foi o AbstRAct

AimsTo evaluate a telemonitoring strategy based on automated text messaging and telephone support after heart failure (HF) hospitalization. Methods and resultsThe MESSAGE-HF study is a prospective multicentre, randomized, nationwide trial enrolling patients from 30 clinics in all regions of Brazil. HF patients with reduced left ventricular ejection fraction (<40%) and access to mobile phones are eligible after an acute decompensated HF hospitalization. Patients meeting eligibility criteria undergo an initial feasibility text messaging assessment and are randomized to usual care or telemonitoring intervention. All patients receive a HF booklet with basic information and recommendations about self-care. Patients in the intervention group receive four daily short text messages (educational and feedback) during the first 30 days of the protocol to optimize self-care; the feedback text messages from patients could trigger diuretic adjustments or a telephone call from the healthcare team. After 30 days, the frequency of text messages can be adjusted. Patients are followed up after 30, 90, and 180 days, with final status ascertained at 365 days by telephone. Our primary endpoint is the change in N-terminal pro-brain natriuretic peptide (NT-proBNP) levels after 180 days. Secondary endpoints include changes in NT-proBNP after 30 days; health-related quality of life, HF self-care, and knowledge scales after 30 and 180 days; and a composite outcome of HF hospitalization and cardiovascular death, adjudicated by a blinded and independent committee. Conclusions The MESSAGE-HF trial is evaluating an educational and self-care promotion strategy involving a simple, intensive, and tailored telemonitoring system. If proven effective, it could be applied to a broader population worldwide.

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