Background: Adherence to treatment after a myocardial infarction (MI) is poor, even in the early postinfarction period. Combining evidence-based drugs into a multicap could improve adherence in this population. No previous randomized trial assessing fixed-dose combination therapy has included patients early after a MI. We aimed to assess if a multicap containing four secondary prevention drugs increases adherence to treatment at 6 months after MI hospitalization. The study was designed as a randomized, parallel, open-label, controlled trial. Methods: Patients were randomized within 7 days of a MI to either multicap or control group. The multicap group received a capsule containing aspirin, atenolol, ramipril, and simvastatin. The control group received each drug in separate pills. The primary outcome was adherence at 6 months. We also measured blood pressure, heart rate, serum cholesterol levels, C-reactive protein, and platelet aggregation. Results: The study was stopped prematurely when 100 patients were included for futility. At 6 months, 92 (95.8%) patients were adherent to medical treatment: 98.0% in the multicap group and 93.5% in the control group [relative risk (RR) 1.05; 95% confidence interval (CI) 0.96–1.14; p = 0.347]. There were no differences between groups in systolic blood pressure ( p = 0.662), diastolic blood pressure ( p = 0.784), heart rate ( p = 0.533), total cholesterol ( p = 0.760), LDL-c ( p = 0.979), C-reactive protein ( p = 0.399), or in the proportion of patients with adequate platelet aggregation inhibition ( p = 0.600). Conclusions: The study did not find any improvement in the adherence at 6 months after a MI with a multicap-based strategy (Multicap for Increase Adherence After Acute Myocardial Infarction; [ ClinicalTrials.gov identifier: NCT02271178]).

Introducción: La pandemia declarada por la OMS por el virus SARS CoV2 llevó al sistema de salud argentino a prepararse para la atención de casos de COVID-19, pero se desconoce el impacto en este escenario sobre patologías prevalentes, como las cardiovasculares. Material y métodos: Se realizó una encuesta transversal en los centros que participan del registro ARGEN-IAM-ST, que se desarrolló para indagar sobre la organización institucional, la atención ambulatoria, la internación en cuidados críticos y el personal de la salud. Resultados: Se encuestaron 80 centros; el 55% eran de dependencias públicas y el 97% con servicio de cuidados críticos. El 91% de las instituciones formó un comité de crisis por la pandemia. El 65% de los centros tomó medidas de atención ambulatoria por el distanciamiento social. Para el 89% se redujeron los ingresos por patologías cardiovasculares, y la magnitud de la caída tuvo una media de 57% (DE ± 18). En 24% de los centros se registró personal de la salud contagiados con SARS-Cov2. Conclusión: Un elevado porcentaje de centros que participan del registro continuo ARGEN-IAM-ST crearon comités de crisis para reorganizar la atención; casi dos tercios de ellos tomaron medidas para seguimiento ambulatorio y se registró una importante caída de la ocupación de camas de pacientes cardiovasculares.

Prior randomized clinical trials have failed to demonstrate a prognostic benefit of statins in chronic heart failure (CHF), 1,2 and adding fuel to this controversy, Takano et al (PEARL Study Investigators) have reported a neutral prognostic effect of pitavastatin in 574 patients with CHF. 3 Despite these neutral findings, evidence coming from observational studies supports the clinical benefit of statins in prespecified subgroups of patients with HF. 4-6 A post-hoc analysis of the CORONA trial showed lower risk for the composite primary endpoint of cardiovascular death, nonfatal myocardial infarction or stroke associated with the use of statins in the subgroup of patients with lower serum values of NT-pro brain natriuretic peptide (NT-proBNP <102.7 pmol/L) 4 and high serum values of high-sensitivity C-reactive protein (>2 mg/L). 5 Moreover, a post-hoc analysis of the PEARL study showed that the prognostic effect of statins varied according to left ventricular function status, with lower risk of cardiovascular mortality and rehospitalization for HF patients with left ventricular ejection fraction (LVEF) ≥30%, but not in those with LVEF <30% (P-value for interaction 0.018).This hypothesis generating results is what keeps alive the continuous interest in finding the holy grail of statins in CHF. Moreover, this association is supported by clinical and experimental evidence suggesting a putative effect of statins on reducing coenzyme Q10 production and, consequently, its deleterious effects on peripheral and cardiac muscle function. 7 Nevertheless, some methodological issues need to be clarified. For instance, the adjusted analysis in the PEARL study did not include potential confounders such as NT-proBNP and highsensitivity C-reactive protein (their distribution might be unbalanced in both groups of LVEF). In addition, these 2 factors have been shown to differentially modify the association be-tween statins and outcomes in patients with CHF. Other clinical risk factors, not included in the multivariate analysis such as surrogates for renal function, hemoglobin, comorbidities and concomitant treatments, may also have impacted the magnitude and direction of the reported results.