Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%

Association between loop diuretic dose changes and outcomes in chronic heart failure: observations from the ESC-EORP Heart Failure Long-Term Registry

[Abstract] Aims. Guidelines recommend down-titration of loop diuretics (LD) once euvolaemia is achieved. In outpatients with heart failure (HF), we investigated LD dose changes in daily cardiology practice, agreement with guideline recommendations, predictors of successful LD down-titration and association between dose changes and outcomes. Methods and results. We included 8130 HF patients from the ESC-EORP Heart Failure Long-Term Registry. Among patients who had dose decreased, successful decrease was defined as the decrease not followed by death, HF hospitalization, New York Heart Association class deterioration, or subsequent increase in LD dose. Mean age was 66±13 years, 71% men, 62% HF with reduced ejection fraction, 19% HF with mid-range ejection fraction, 19% HF with preserved ejection fraction. Median [interquartile range (IQR)] LD dose was 40 (25–80) mg. LD dose was increased in 16%, decreased in 8.3% and unchanged in 76%. Median (IQR) follow-up was 372 (363–419) days. Diuretic dose increase (vs. no change) was associated with HF death [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.12–2.08; P = 0.008] and nominally with cardiovascular death (HR 1.25, 95% CI 0.96–1.63; P = 0.103). Decrease of diuretic dose (vs. no change) was associated with nominally lower HF (HR 0.59, 95% CI 0.33–1.07; P = 0.083) and cardiovascular mortality (HR 0.62 95% CI 0.38–1.00; P = 0.052). Among patients who had LD dose decreased, systolic blood pressure [odds ratio (OR) 1.11 per 10 mmHg increase, 95% CI 1.01–1.22; P = 0.032], and absence of (i) sleep apnoea (OR 0.24, 95% CI 0.09–0.69; P = 0.008), (ii) peripheral congestion (OR 0.48, 95% CI 0.29–0.80; P = 0.005), and (iii) moderate/severe mitral regurgitation (OR 0.57, 95% CI 0.37–0.87; P = 0.008) were independently associated with successful decrease. Conclusion. Diuretic dose was unchanged in 76% and decreased in 8.3% of outpatients with chronic HF. LD dose increase was associated with worse outcomes, while the LD dose decrease group showed a trend for better outcomes compared with the no-change group. Higher systolic blood pressure, and absence of (i) sleep apnoea, (ii) peripheral congestion, and (iii) moderate/severe mitral regurgitation were independently associated with successful dose decrease

Comunicado, G.E. José Boiteux, out, 1943, SC

O comunicado contém 2 p. e foi escrito em um caderno do tipo brochura. Esse material é uma fotografia digitalizada de um comunicado escolar escrito pela professora Orlandina Buchele Brognoli do primeiro ano “S” do Grupo Escolar José Boiteux, João Pessoa, Barro da cidade de Jaraguá do Sul/SC. O original encontra-se disponível na APESC - Arquivo Público do Estado de Santa Catarina. Digitalização gentilmente cedida pela pesquisadora Vanessa da Silva Pires que mobilizou este documento na sua pesquisa de mestrado “Comunicados Escolares: reflexões e apontamentos sobre o ensino de matemática com base nas palavras dos professores catarinenses (1941 – 1950)”O documento é um comunicado escolar escrito pela professora Orlandina Buchele Brognoli no qual ela fala sobre a importância de se ensinar aritmética não apenas nas aulas de matemática, mas tambêm, quando se tiver oportunidade, nas outras disciplinas. Posteriormente a diretora Eulina A de G. Marcelino comenta, concordando com o posicionamento da professora. O comunicado está dividido em Enunciado, Argumentos e Conclusão, além do comentário feito pela diretora

TRATTAMENTO DEL DOLORE CRONICO OSTEOARTICOLARE: QUALE IL RUOLO DEI FANS

Il dolore osteoarticolare \ue8 il sintomo pi\uf9 limitante nei pazienti affetti da patologie degenerative dell\u2019apparato muscoloscheletrico (artrite, artrosi, gotta) e rappresenta ancor oggi una problematica aperta, in quanto non sono stati identificati trattamenti adeguati al suo sollievo. I FANS costituiscono la soluzione terapeutica pi\uf9 frequentemente impiegata, soprattutto in Italia. Tuttavia, essi presentano un profilo farmacologico non idoneo a un impiego cronico. Infatti, pur risultando estremamente efficaci nell\u2019alleviare il dolore osseo e articolare, sia continuo che incidente, determinano l\u2019insorgenza di importanti effetti collaterali a livello gastrico e renale. Recentemente sono stati commercializzati dei farmaci COX-2 inibitori selettivi, che sembrerebbero risultare pi\uf9 sicuri nell\u2019impiego cronico, diminuendo l\u2019incidenza di patologie gastriche, anche se mantengono un\u2019azione nefropatica. I COX-2 inibitori selettivi possono risultare utili nel trattamento cronico del dolore osteoarticolare in associazione ad altri tipi di farmaci, quali gli oppiacei, o ad altri provvedimenti terapeutici. L\u2019utilizzo dei FANS non selettivi dovrebbe essere limitato al trattamento delle riacutizzazioni del dolore che frequentemente si verificano nelle patologie osteoarticolari

Measure of head acceleration referred to vestibular coordinates

Calgary, Canad

Anestesia TIVA in chirurgia Maxillo-facciale: ipotensione versus normotensione e sue correlazioni con la profondit\uf2 del piano di narcosi e l\u2019entit\ue0 del sanguinamento intraoperatorio

missin