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Background & Objective: Despite the burden of sudden cardiac arrest (SCA) worldwide, implantable cardioverter-defibrillators (ICDs) are underutilized, particularly in Asia, Latin America, Eastern Europe, the Middle East, and Africa. The Improve SCA trial demonstrated that primary prevention (PP) patients in these regions benefit from an ICD or a cardiac resynchronization therapy defibrillator (CRT-D). We aimed to compare the rate of device therapy and mortality among ischemic and non-ischemic cardiomyopathy (ICM and NICM) PP patients who met guideline indications for ICD therapy and had an ICD/CRT-D implanted. Methods: Improve SCA was a prospective, non-randomized, non-blinded multicenter trial that enrolled patients from the above-mentioned regions. All-cause mortality and device therapy were examined by cardiomyopathy (ICM vs NICM) and implantation status. Cox proportional hazards methods were used, adjusting for factors affecting mortality risk. Results: Of 1848 PP NICM patients, 1007 (54.5%) received ICD/CRT-D, while 303 of 581 (52.1%) PP ICM patients received an ICD/CRT-D. The all-cause mortality rate at 3 years for NICM patients with and without an ICD/CRT-D was 13.1% and 18.3%, respectively (HR 0.51, 95% CI 0.38e0.68, p < 0.001). Similarly, all-cause mortality at 3 years in ICM patients was 13.8% in those with a device and 19.9% in those without an ICD/CRT-D (HR 0.54, 95% CI 0.33e.0.88, p ¼ 0.011). The time to first device therapy, time to first shock, and time to first antitachycardia pacing (ATP) therapy were not significantly different between groups (p 0.263). Conclusions: In this large data set of patients with a guideline-based PP ICD indication, defibrillator device implantation conferred a significant mortality benefit in both NICM and ICM patients. The rate of appropriate device therapy was also similar in both groups.
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Abstract Background: Implantable cardiac defibrillators (ICDs) therapy for primary prevention (PP) of sudden cardiac arrest (SCA) is well-established but underutilized globally. The Improve SCA study has identified a cohort of patients called 1.5 primary prevention (1.5PP), based on PP patients with the presence of documented risk factors: non-sustained ventricular tachycardia, frequent premature ventricular contractions, left ventricular ejection fraction < 25%, and pre-syncope or syncope. Objective: This study evaluated the cost-effectiveness of ICD therapy compared to no ICD among 1.5PP patients in the Brazilian public healthcare system. Methods: Modified inputs to a published Markov model were applied to compare costs and outcomes of ICD therapy to no ICD therapy from the Brazilian payer's perspective. Mortality and utility estimates were obtained from the IMPROVE SCA trial. Additional effectiveness inputs were sourced from the literature. Cost inputs were obtained from the Brazilian Unified Health System and the Ministry of Health. Costs were discounted at 4.7%; quality-adjusted life years (QALYs) were discounted at 1.45%. This study applied a willingness-to-pay (WTP) value of three times Brazil's gross domestic product (GDP) in 2017, R$105,723 (Brazilian Real). Results: The total discounted lifetime costs for ICD therapy were R$100,920 compared to R$43,866 for no ICD therapy. Total discounted QALYs for ICD therapy and no ICD therapy were 9.85 and 7.15, respectively. The incremental cost effectiveness ratio was R$21,156 per QALY and less than the R$105,723 WTP threshold. Results from sensitivity analyses were consistent with base case results. Conclusions: ICD therapy compared to no ICD therapy is cost-effective in the 1.5PP population in Brazil. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)
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Resumen Objetivo: medir el impacto de la terapia de resincronización cardiaca en términos de variables ecocardiográficas en pacientes de países latinoamericanos. Método: se realizó un estudio prospectivo, multicéntrico, intervencionista, en el que los pacientes elegibles fueron llevados, por primera vez, a implante de un dispositivo de resincronización cardiaca. El objetivo primario fue valorar los cambios del tamaño y la función del ventrículo izquierdo por medio de un ecocardiograma previo al implante del dispositivo y en el sexto mes. Los objetivos secundarios evaluados fueron hospitalizaciones, cambios en la clase funcional, mortalidad, calidad de vida y un score compuesto clínico basado en estos factores de evaluación global del paciente. Resultados: para cumplir el objetivo primario se analizaron datos de 75 sujetos. La edad promedio fue de 63,7 años; 21.3% fueron mujeres y 30.7% tuvieron cardiopatía isquémica. Al sexto mes de seguimiento las mediciones de volumen de fin de diástole y sístole del ventrículo izquierdo disminuyeron en promedio 37.6 ml y 37.8 ml, respectivamente. La fracción de eyección del ventrículo izquierdo en promedio se incrementó un 11%. El puntaje compuesto clínico mostró mejoría en el 86.4% de los pacientes en el sexto mes postimplante del resincronizador. Conclusiones: se observó remodelado inverso del ventrículo izquierdo y mejoría en el estado clínico de los pacientes con insuficiencia cardiaca y disfunción sistólica del ventrículo izquierdo que recibieron terapia de resincronización cardiaca en el ámbito de la práctica clínica de rutina.
Abstract Objective: To measure the impact of cardiac resynchronisation therapy in terms of cardiac ultrasound variables in patients from Latin-American countries. Method: A prospective, multicentre, interventionist study was conducted, in which the eligible patients were those that had a cardiac resynchronisation device implanted for the first time. The primary objective was to assess the changes in size and left ventricular function by means of a cardiac ultrasound carried out prior to implanting the device and in the sixth month. The secondary objectives evaluated were hospital admissions, change in functional class, mortality, quality of life, and an overall assessment of the patient using a combined clinical score based on these factors. Results: A total of 75 subjects were analysed in order to complete the primary objective. The mean age was 63.7 years; 21.3% were female, and 30.7% had ischaemic heart disease. At the sixth month, the left ventricular end-diastolic and systolic volume decreased by a mean of 37.6 ml and 37.8 ml, respectively. The left ventricular ejection fraction increased by a mean of 11%. The combined clinical score showed an improvement in 86.4% of the patients in the sixth month after the implantation of the synchronisation device. Conclusions: A reverse remodelling of the left ventricle was observed, as well as an improvement in the clinical stage of patients with heart failure and left ventricular systolic dysfunction that received cardiac resynchronisation treatment in the setting of routine clinical practice.
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Humans , Female , Middle Aged , Cardiac Resynchronization Therapy , Heart Failure , Therapeutics , Echocardiography , MortalityABSTRACT
En las últimas décadas ha crecido el estudio los mecanismos involucrados en el comportamiento social, gran parte de estas indagaciones se han realizado desde una aproximación de la neurociencia social cognitiva, la cual se basa en un modelo representacional del procesamiento de información. No obstante, esta aproximación ha sido ampliamente criticada por desconocer la participación del cuerpo, la dinámica afectiva, el contexto social, el cambio durante el desarrollo y suponer un procesamiento modular endógeno. En este sentido, este artículo presenta un modelo neurodinámico de la cognición social (CS), comprendiéndola desde una aproximación enactiva, situada, relacional y sistémica. Desde este modelo se describen los principales cambios en esperados la actividad cerebral durante las interacciones sociales en tiempo real y durante la ontogenia. Se concluye resaltando los desafíos y oportunidades que este tipo de aproximaciones puede proporcionar a la neurociencia y psicología social del futuro.
In recent decades it has seen a growing interest to study the mechanisms involved in social behavior, much of these inquiries fall within social cognitive neuroscience approach, which is based on a representational model of information processing. However, this approach has been widely criticized for ignoring the body participation, emotional dynamics, social context, developmental changes and assuming an endogenous modular processing. In this regard, this article presents a neurodynamic model of social cognition, which understand social process from an enactive, embodied, situated, relational and systemic perspective. This model let us described the main expected changes in brain activity during ongoing social interactions and ontogeny. The conclusion highlights the challenges and opportunities that this kind of approach can provide for a coming neuroscience and social psychology.
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La investigación en comprensión emocional ha privilegiado el estudio de los antecedentes y ha desatendido el que atañe al conocimiento sobre las consecuencias de las emociones. Se diseñó una tarea para niños de dos rangos de edad (4 a 5 y 5 a 6 años) con dos historias (valencias positivay negativa). Se midió la concordancia entre valencias (consecuencia-historias), y la calidad de las justificaciones sobre la elección de la consecuencia. Se encontró que la concordancia cambia en función de la edad, la valencia de las historias y las justificaciones a la elección de la consecuencia; las justificaciones dependen de la edad; existe una relación estrecha entre el desarrollo de la comprensión de las consecuencias y la regulación emocional.
Research about emotional understanding has privileged the study of antecedents, but has missed the study of knowledge of the consequences of emotions. We created a task for children of two ages (4 to 5 and 5 to 6 years) with two stories (positive and negative valences). We assessed the valences concordance (consequence-stories), and the justification quality on the consequence election. We found that concordance changes in function of age, story valence and justifications; justifications depend on age; there is a close relation between the developmentof understanding of emotional consequences and emotional regulation.
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Humans , Emotions , Stress, Psychological/psychologyABSTRACT
El presente informe describe los hallazgos clínicos y polisomnográficos en una mujer con antecedentes de síndrome de Guillain-Barré que refería hipersomnia diurna relacionada con moviminetos periódicos del sueño.