Cardiología

Awareness, attitudes, and barriers toward Transthyretin Amyloid Cardiomyopathy in Latin America: A questionnaire-based cross-sectional study.

Fri, 26 Jun 2026 00:00:00 GMT

Awareness, attitudes, and barriers toward Transthyretin Amyloid Cardiomyopathy in Latin America: A questionnaire-based cross-sectional study. Camacho-Hubner, Cecilia; Waddington Cruz, Marcia; Rodríguez González, María Juliana; Simões, Marcus Vinicius; López-Ponce de León, Juan David; Fernandes, Fabio; Martínez Carreño, Erika María; Costabel, Juan Pablo; Berríos Bárcenas, Enrique A.; Barroso, Fabio Adrián; Cigarroa López, José Angel; Ortega Reyes, Rosa; Alvarez, Jaime; Pérez de Arenaza, Diego; Buitrago, Diana; Otero, Constanza; Bertoli de Souza, Claudenice Leite; Molina Gómez, Juan Sebastián; Silva Julian, Guilherme Background: Cardiac Amyloidosis (CA), specifically Transthyretin Amyloid Cardiomyopathy (ATTR-CM), is an under-recognized, progressive, and fatal disease. Comprehensive primary data describing awareness, attitudes, and barriers to treatment in Latin America (LATAM) are lacking, highlighting a gap between guidelines and real-world clinical practice. Methods: A cross-sectional, questionnaire-based observational study was conducted among 470 physicians actively involved in patient management across 8 LATAM countries (June-August 2023). The study assessed their awareness, attitudes, and barriers concerning ATTR-CM. Descriptive analysis was performed. Results: Limited knowledge of ATTR-CM was observed. Awareness of its pathophysiology was reported by 50.2%. Patients consulted 4-5 physicians before receiving a confirmed diagnosis. Cardiologists managed most day-to-day cases (76.2%). Transthyretin genetic testing was available to only 26.4%. Local treatment protocols relied on international guidelines (87.4%), with Real-World Data considered important by 60.6%. Patient cost and access to tafamidis were frequently reported barriers. Follow-up commonly relied on echocardiography, NT-pro BNP, NYHA classification, and ECG/Holter ECG. Conclusions: Difficulties in ATTR-CM diagnosis and management in LATAM were influenced by varying knowledge levels, gaps in diagnostic algorithms, and significant access barriers. These factors contribute to delayed diagnosis and management. Enhanced, tailored training strategies and collaborative efforts are necessary to improve early diagnosis, effective treatment, and ultimately, patient outcomes in the region.

Epidemiology and risk factors of stroke in the Americas: a comprehensive narrative literature review

Fri, 22 May 2026 00:00:00 GMT

Epidemiology and risk factors of stroke in the Americas: a comprehensive narrative literature review Sampaio Silva, Gisele; Diestro, Jose Danilo; Tarzi, Christopher; Kishibe, Teruko; Bernabé-Ortiz, Antonio; Carrillo Larco, Rodrigo M.; Ovbiagele, Bruce; Saposnik, Gustavo; Abanto, Carlos; Alet, Matías Javier; Almarie, Bassel; Álvarez, Tony Fabián; Amaya, Pablo; Ameriso, Sebastián Francisco; Arauz, Antonio; Barboza, Miguel A.; Bayona, Hernán; Calleja, Juan; Cano Nigenda, Vanessa; Pujol Lereis, Virginia Andrea Stroke remains a leading cause of death and disability across the Americas, disproportionately affecting low- and middle-income countries. According to the 2023 Global Burden of Disease (GBD) Study, the Americas recorded approximately 1.2 million incident strokes and 15.7 million prevalent cases. This narrative review synthesizes epidemiological evidence on stroke trends in the Americas, with emphasis on disparities in healthcare access. We integrated estimates from the GBD, peer-reviewed studies and national surveillance systems. Although age-standardized stroke rates declined after 1990, recent analyses demonstrate a concerning resurgence, particularly among younger adults. Stroke incidence, prevalence, and disability burden vary widely across countries. Latin America and the Caribbean show higher incidence but lower prevalence than high-income settings, reflecting limited access to acute care and higher case fatality. Socioeconomic and racial inequities drive delayed treatment and poorer functional outcomes. Over 75% of stroke burden is attributable to modifiable risk factors. Urgent system-level action is needed.

Cierre de foramen oval permeable guiado por ecocardiografía intracardíaca: resultados iniciales y descripción de la técnica

Wed, 01 Jan 2025 00:00:00 GMT

Cierre de foramen oval permeable guiado por ecocardiografía intracardíaca: resultados iniciales y descripción de la técnica Magariños, Eduardo; Henestrosa, Germán; Scuteri, Antonio; Romano, Ariel; Sandoval, Carla Elizabeth; Pujol Lereis, Virginia Andrea; Ameriso, Sebastián Francisco Introducción: El cierre percutáneo del foramen oval permeable (FOP) está establecido como tratamiento para prevención secundaria de un nuevo accidente cerebrovascular (ACV) en un grupo seleccionado de pacientes. En este trabajo se analizan los resultados iniciales del cierre percutáneo, asistido por ecocardiografía intracardíaca (ECI), en 226 pacientes consecutivos de un solo centro. Adicionalmente se realiza una descripción de la técnica empleada. Objetivo: Analizar los resultados iniciales y evolución intrahospitalaria de 226 pacientes consecutivos en quienes se intentó cierre de un FOP asistido por ECI. Además, describir la técnica utilizada. Resultados: Del 21 de noviembre de 2016 al 25 de agosto de 2025, en 226 pacientes con ACV un ECI confi rmó la presencia de FOP. En estos pacientes se intentó cierre percutáneo asistido por ECI. Se obtuvo cierre del FOP en el 100% de los casos; las complicaciones mayores fueron del 0% y 7,5% presentaron complicaciones menores. Conclusiones: En el grupo de pacientes analizados el cierre percutáneo del FOP con la técnica empleada fue exitoso en un elevado número de casos, no ocurrieron complicaciones mayores y las complicaciones menores fueron del 7,5%.

Global patterns of polypharmacy after acute heart failure hospitalization: Prevalence and outcomes from the REPORT-HF registry

Mon, 01 Dec 2025 00:00:00 GMT

Global patterns of polypharmacy after acute heart failure hospitalization: Prevalence and outcomes from the REPORT-HF registry Wan Ting, Tay; Tiew-Hwa Katherine, Teng; Ouwerkerk, Wouter; John G.F., Cleland; Sean P., Collins; Christiane E., Angermann; Kenneth, Dickstein; Ulf, Dahlstrom; Anja, Schweizer; Achim, Obergfell; Kai-Hang, Yiu; Mathieu, Ghadanfar; Mahmoud, Hassanein; Qing-Wen, Ren; Wen-Li, Gu; Georg, Ertl; Sergio Víctor, Perrone; Gerasimos, Filippatos; Carolyn S.P., Lam; Jasper, Tromp Aims: Polypharmacy, defined as the concurrent use of ≥5 medications, is prevalent among older adults with heart failure (HF). While guideline-directed HF medications provide therapeutic benefits, non-HF polypharmacy, particularly involving inappropriate medications, may lead to adverse outcomes. The international REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure (REPORT-HF), the largest available global acute HF registry, was used to examine the prevalence, clinical correlates, and 1-year outcome associations of non-HF polypharmacy. Methods and results: Medication counts were classified as no polypharmacy (<5), polypharmacy (5-9), and hyper-polypharmacy (≥10). Potentially harmful medications were identified using the 2016 American Heart Association scientific statement. Multivariable regression models examined correlates of polypharmacy and 1-year mortality. Among 18 030 patients (66 ± 14 years, 39% women), 39% had polypharmacy and 9% had hyper-polypharmacy (63% and 25%, respectively, if including HF medications). Non-HF polypharmacy was more common in older white patients from high-income countries, with preserved ejection fraction and high comorbidity burden. Patients with greater non-HF medication use were less likely to receive guideline-directed HF medications and more likely to take medications that can worsen HF. Crude hazard ratios (HRs) for 1-year mortality were 1.16 (95% confidence interval [CI] 1.08-1.25) for polypharmacy and 1.46 (95% CI 1.31-1.63) for hyper-polypharmacy versus no polypharmacy. After adjustment, hyper-polypharmacy remained associated with increased mortality (HR 1.16, 95% CI 1.01-1.33). Conclusions: Non-HF polypharmacy in HF is common worldwide, particularly in high-income regions. Its association with reduced use of guideline-directed HF medications and higher usage of medications causing or worsening HF, as well as elevated 1-year mortality, underscores the importance of addressing polypharmacy in HF.