ABSTRACT
BACKGROUND: Clinical management of cardiac resynchronization therapy (CRT) non-responders is difficult, and their prognosis is poor. The aim of the present study was to evaluate whether treatment with sacubitril/valsartan can improve quality of life (QoL) parameters in these patients. METHODS: Thirty five non-responders to CRT were included (75 ± 7 years, 28% females, mean left ventricular ejection fraction 28 ± 8%, 54% non-ischemic cardiomyopathy) with maximally optimized drug therapy and New York Heart Association class II-III. They were all on angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and were switched to sacubitril/valsartan. One week before and 6 months after initiation of the therapy they completed both the Minnesota Living with Heart Failure (MLWHF) and the 12-item Kansas City Cardiomyopathy Questionnaires (KCCQ-12). The primary outcome was the effect of sacubitril/valsartan on the physical, clinical, social and emotional QoL parameters and number of hospitalizations. RESULTS: The mean total scores of both questionnaires improved from baseline to the follow-up visit at 6-months (KCCQ-12 40 ± 10 to 47 ± 10; p < 0.001; MLWHF 40 ± 15 to 29 ± 15; p < 0.001). The best results were seen in the KCCQ-12 total symptom domains (77% improvement), the MLWHF physical domain (81% improvement), and the MLWHF emotional domain (71% improvement). Two patients died during follow-up. The mean number of hospitalizations reduced significantly (1 ± 0.6 vs. 0.5 ± 0.8; p = 0.003) CONCLUSIONS: In CRT non-responders, sacubitril/valsartan significantly improved overall QoL, physical limitations and emotional domains and reduced the number of hospitalizations.
Subject(s)
Cardiac Resynchronization Therapy , Heart Failure , Aged , Aged, 80 and over , Aminobutyrates/therapeutic use , Angiotensin Receptor Antagonists/therapeutic use , Angiotensins , Biphenyl Compounds , Drug Combinations , Female , Heart Failure/diagnosis , Heart Failure/drug therapy , Humans , Male , Neprilysin , Quality of Life , Registries , Stroke Volume , Tetrazoles/therapeutic use , Treatment Outcome , Valsartan , Ventricular Function, LeftABSTRACT
Bleeding risk stratification is an unresolved issue in older adults. Anemia may reflect subclinical blood losses that can be exacerbated after percutaneous coronary intervention . We sought to prospectively determine the contribution of anemia to the risk of bleeding in 448 consecutive patients aged 75 or more years, treated by percutaneous coronary interventions without concomitant indication for oral anticoagulation. We evaluated the effect of WHO-defined anemia on the incidence of 1-year nonaccess site-related major bleeding. The prevalence of anemia was 39%, and 13.1% of anemic and 5.2% of nonanemic patients suffered a bleeding event (hazard ratio 2.75, 95% confidence interval 1.37 to 5.54, pâ¯=â¯0.004). Neither PRECISE-DAPT nor CRUSADE scores were superior to hemoglobin for the prediction of bleeding. In conclusion, anemia is a powerful predictor of bleeding with potential utility for simplifying tailoring therapies.
Subject(s)
Acute Coronary Syndrome/surgery , Anemia/epidemiology , Coronary Artery Disease/surgery , Percutaneous Coronary Intervention/methods , Platelet Aggregation Inhibitors/therapeutic use , Postoperative Hemorrhage/epidemiology , Acute Coronary Syndrome/epidemiology , Aged , Aged, 80 and over , Angina, Unstable/epidemiology , Angina, Unstable/surgery , Anticoagulants/therapeutic use , Antithrombins/therapeutic use , Aspirin/therapeutic use , Cause of Death , Clopidogrel/therapeutic use , Comorbidity , Coronary Artery Disease/epidemiology , Drug-Eluting Stents , Female , Gastrointestinal Hemorrhage/chemically induced , Gastrointestinal Hemorrhage/epidemiology , Gastrointestinal Hemorrhage/mortality , Hemorrhage/chemically induced , Hemorrhage/epidemiology , Hemorrhage/mortality , Heparin/therapeutic use , Hirudins , Humans , Intracranial Hemorrhages/chemically induced , Intracranial Hemorrhages/epidemiology , Intracranial Hemorrhages/mortality , Kaplan-Meier Estimate , Male , Myocardial Infarction/epidemiology , Myocardial Infarction/surgery , Peptide Fragments/therapeutic use , Postoperative Care , Postoperative Hemorrhage/chemically induced , Postoperative Hemorrhage/mortality , Prasugrel Hydrochloride/therapeutic use , Proportional Hazards Models , Prospective Studies , Recombinant Proteins/therapeutic use , Risk Assessment , Stents , Ticagrelor/therapeutic use , Urologic Diseases/chemically induced , Urologic Diseases/epidemiology , Urologic Diseases/mortalityABSTRACT
Rufous-tailed Jacamar Galbula ruficauda is known from few records in Paraguay, all during the last 20 years. The species has been recorded in the northern Chaco and Paraguayan Pantanal, with all confirmed records from Alto Paraguay department. Here we summarise all reports and localities of the species in Paraguay to date. The species is categorized as Data Deficient at the national level, but may be more widely distributed than is currently recognised.
Galbula ruficauda es una especie que cuenta con pocos registros a lo largo de 20 años en Paraguay. La especie ha sido observada en la zona norte del Chaco y Pantanal paraguayo, departamento Alto Paraguay. En este trabajo reportamos los registros y localidades de ocurrencia de la especie en el país. Actualmente se encuentra en la categoría de Datos Insuficientes a nivel nacional, aunque puede ser que su distribución sea más amplia.
