Cost-effectiveness in unstable economies: the case of sacubitril/valsartan in heart failure with reduced ejection fraction in Argentina.

Background: Sacubitril/valsartan (an Angiotensin receptor-neprilysin inhibitor-ARNI) is one of the cornerstones in the management of patients with heart failure with reduced ejection fraction (HFrEF) having demonstrated significant reductions in both mortality and hospitalisations as compared with enalapril. It proved to be a cost-effective treatment in many countries with stable economies. In Argentina, a country with chronic financial instability and a fragmented health care system, the estimation of its cost-effectiveness requires to consider local financial data.

Direct Oral Anticoagulants: An Updated Systematic Review of Their Clinical Pharmacology and Clinical Effectiveness and Safety in Patients With Nonvalvular Atrial Fibrillation.

Direct oral anticoagulants have been an increasingly used class of drugs in the setting of nonvalvular atrial fibrillation, defying vitamin K antagonists' monopoly when it comes to anticoagulation due to its several limitations. Direct oral anticoagulants (DOACs) have entered the market as a noninferior and safer option in comparison with vitamin K antagonists, as their respective phase III clinical trials proved. The aim of this article was to update and summarize data on their clinical pharmacology and to review real-world data to know their comparative effectiveness and safety.

Real-world data meta-analysis: procedural success and clinical outcomes after radiofrequency ablation of atrial fibrillation in South America.

Objective: To profile patients' characteristics, in-hospital results, and recurrence rates after radiofrequency ablation of atrial fibrillation (RAAF) in South America.

Methods: We comprehensively searched for single-center studies from South America with ≥10 patients receiving RAAF, published or presented from January 1, 2010, through June 29, 2020, excluding those reports aimed to specific populations such as permanent atrial fibrillation, structural cardiopathies, or re-do procedures.

Results: Main pooled estimates from a random-effects meta-analysis that included 3909 patients from 27 cohorts (from 5 countries): a) Patients characteristics: age 57.

Temporal Trends in Self-Expandable Transcatheter Aortic Valve Replacement in South America: A Systematic Review and Meta-Analysis.

Objectives: This study aimed to estimate temporal trends in clinical presentation and short-term outcomes of transcatheter aortic valve replacement (TAVR) with self-expandable prostheses in South America through a systematic review and meta-analysis of observational data.

Methods: We comprehensively searched for articles published in peer-reviewed medical journals and for abstracts presented in medical conferences of the region from September 1, 2008, to June 29, 2020. We included single-center studies on self-expandable TAVR populations with ≥ 10 patients from South America.

Clinical outcomes after transcatheter aortic valve replacement in South America: A centre-level systematic review and meta-analysis of observational data.

Objectives: To estimate in-hospital and 30-day outcomes after transcatheter aortic valve replacement (TAVR) in South America through a systematic review and meta-analysis of observational data.

Methods: We comprehensively searched for papers published in peer-reviewed medical journals and for abstracts presented in medical conferences of the region from 1 September 2008, through 29 June 2020, using predefined criteria. We included single-centre studies on TAVR populations with ≥10 patients from South America reporting any in-hospital or 30-day clinical outcome.

Agent-based computational models to explore diffusion of medical innovations among cardiologists.

Background: Diffusion of medical innovations among physicians rests on a set of theoretical assumptions, including learning and decision-making under uncertainty, social-normative pressures, medical expert knowledge, competitive concerns, network performance effects, professional autonomy or individualism and scientific evidence.

Objectives: The aim of this study was to develop and test four real data-based, agent-based computational models (ABM) to qualitatively and quantitatively explore the factors associated with diffusion and application of innovations among cardiologists.

Methods: Four ABM were developed to study diffusion and application of medical innovations among cardiologists, considering physicians' network connections, leaders' opinions, "adopters' categories", physicians' autonomy, scientific evidence, patients' pressure, affordability for the end-user population, and promotion from companies.

Estimation of the cost-effectiveness of apixaban versus vitamin K antagonists in the management of atrial fibrillation in Argentina.

Apixaban, a novel oral anticoagulant which has been approved for the prevention of stroke and systemic embolism in non-valvular atrial fibrillation, reduces both ischemic and haemorrhagic stroke and produces fewer bleedings than vitamin K antagonist warfarin. These clinical results lead to a decrease in health care resource utilization and, therefore, have a positive impact on health economics of atrial fibrillation. The cost-effectiveness of apixaban has been assessed in a variety of clinical settings and countries.

[Diffusion and adoption of health care innovations in cardiology, in Argentina].

Background: Medicine is changing rapidly and diagnostic and therapeutic innovations are common. Not all professionals adopt these innovations in the same way.

Aim: To survey the physicians' opinions on adopting innovations in cardiovascular health care, to classify individuals from an innovative to a conservative behavior, and to individualize opinion leaders among them, in order to build a social network of influence.

[Patients' preferences for information in health care decision-making].

A survey was carried out among patients who concurred to cardiologic services to know how patients preferred to be informed about their health status, and the demographic characteristics associated to these preferences, considering the following items: knowledge about the disease, information about different therapeutic options and decision-making. From 770 people surveyed, 738 (95.8%) answered the form completely.

Rivaroxaban in atrial fibrillation.

Warfarin is the traditional therapeutic option available to manage thromboembolic risk in atrial fibrillation. The hemorrhagic risk with warfarin depends mainly on the international normalized ratio (INR). Data from randomized controlled trials show that patients have a therapeutic INR (2.

The production of articles on cardiology from Latin America in Medline indexed journals.

Introduction: Latin America has dramatically increased the number of articles Publisher from 1995 to 2002, but the individual contribution of each country appears to be very unequal.

Objectives: To analyze the production of articles on Cardiology research published in Latin American countries in the past years in international journals.

Methods: A bibliography search was carried out throughout PubMed in regards to biomedical articles in general and on Cardiology in particular, corresponding to the period 1987-2006.

Pharmacogenomics and adverse drug reactions: the case of statins.

Introduction: The use of genomics to predict adverse drug reactions (ADRs) has been the subject of much research over the last decade. Concerns about the muscular safety of statins, a highly prescribed group of drugs, are partially related to their high exposure. Many studies have identified a variety of genetic markers related to statin-induced myopathy.

Changing anticoagulant paradigms for atrial fibrillation: dabigatran, apixaban and rivaroxaban.

Introduction: Vitamin K antagonists (VKAs) are the main therapeutic agents used to prevent embolic events in patients with atrial fibrillation (AF). Despite their proven efficacy, VKAs are underused and have several limitations. In recent years, there has been great interest in the development of new oral anticoagulants with a more efficient pharmacological profile, first tested in venous thromboembolism prevention and later in AF.

Beyond efficacy: pharmacokinetic differences between clopidogrel, prasugrel and ticagrelor.

Introduction: Clinical nonresponse to clopidogrel has been associated with variability in response. This has led to the development of other P2Y12 receptor inhibitors, such as prasugrel and ticagrelor, with different pharmacokinetic characteristics that influence their pharmacodynamics.

Areas Covered: Clopidogrel response variability is attributable to its complex pharmacokinetics and is vulnerable to genetic polymorphisms in genes involved in absorption, metabolism and drug-drug interactions (i.

Nonresponders to clopidogrel: pharmacokinetics and interactions involved.

Importance Of The Field: The use of clopidogrel and aspirin has become standard therapy in patients with acute coronary syndromes and stent implantation. However, concern arises because about 25% of subjects are nonresponders to clopidogrel. This nonresponsiveness is associated with a threefold increase in adverse outcomes.

QT interval prolongation: preclinical and clinical testing arrhythmogenesis in drugs and regulatory implications.

The assessment about the proarrhythmic risk associated with a particular drug is a major requirement for drugs under development, since many drugs have been withdrawn from market or got under strict pharmacological vigilance because of such a risk. Predicting the development of a life-threatening arrhythmia is a hard task but, in the case of TdP ("Torsades de Pointes"), there are some useful markers. Among them, the prolongation of the QT interval and its heart rate correction (QTc) are the most remarkable.

[Medical students' attitudes regarding professional practice].

Although the choice to study medicine implies some knowledge of the current working situation of practitioners, medical students' expectations regarding their future professional practice have been rarely investigated in Argentina. The aim of this work was to collect data about the expectations of senior medical students regarding their future professional practice. One hundred and twenty-five senior medical students were surveyed between September and December 2008.

[Survey of medical attitudes towards a "case scenario" of encephalopathy after cardiac arrest].

Recent studies have shown that the timing of death is often under the control of the physicians who treat the patient in intensive care unit (ICU), where death is commonly preceded by decisions either not to start an aggressive therapy or to discontinue life-sustaining therapy. The objective was to study end-of-life decisions and attitudes of Argentinian cardiologists when treating terminal patients in the ICU. During 2007, a survey by e-mail was carried out among 967 cardiologists across Argentina.

Perception of consultation length in cardiology and its ethical implications.

Objectives: This study considered whether the time employers allotted to medical consultations in many working environments in Argentina might be inadequate to carry out an interview. The objective was to conduct a survey to gather information on the length of cardiologic medical consultations in Argentina.

Methods: During 2007, a survey was carried out that included 816 cardiologists.