In hospital settings, awareness of, and responsiveness to, COVID-19 are crucial to reducing the risk of transmission among healthcare workers (HCWs) and protecting them from infection. Healthcare professionals can offer insights into the practicalities of infection prevention and control measures and on how the protective equipment and training could best be delivered during the pandemic. This study aimed to inform the development of future recommendations to optimise compliance with appropriate use of these measures, and to improve the guidance to reduce their risk of the disease. Drawing on in-depth interviews with HCWs in a hospital in Thailand, several factors influence the use of multiple prevention measures: concerns about infection, availability of the equipment supply, barriers to work performance, and physical limitations in the hospital setting. Setting a ventilated outdoor space for screening and testing, and interaction through mobile technology, were perceived to reduce the transmission risk for staff and patients. Adequate training, clear guidelines, streamlined communications, and management support are crucial to encourage appropriate use of, and adherence to, implementation of infection prevention and control (IPC) measures among HCW. Further study should explore the perceptions and experience of health professionals in local health facilities and community-based workers during the pandemic, particularly in resource-limited settings.

Background Heart failure with reduced ejection fraction (HFrEF) is the global public health burden with a prevalence of 1% of adults. The current guidelines suggest the use of angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), angiotensin receptor-neprilysin inhibitors (ARNIs), and sodium-glucose cotransporter-2 inhibitors (SGLT2i) to reduce mortality. Soluble guanylyl cyclase (sGC) and omecamtiv mecarbil (OMM) have also been studied in HFrEF. However, there has been no head-to-head comparison of the efficacy and cumulative incidence interpretation of the outcome of the novel drugs. Purpose To compare all drugs and possible combinations of guideline-directed medical therapy (GDMT) including ACEI, ARB, BB, and MRA, and novel drugs including ivabradine (IVA), ARNI, SGLT2i, sGC and OMM to find the best additional novel drug to the GDMT. Methods This network meta-analysis (MA) is part of the study registered on PROSPERO (CRD42021262029). A systematic search of MAs and randomised controlled trials (RCT) was performed on biomedical databases from inception to June 2021. All MAs and RCTs were selected against eligibility criteria. A primary composite outcome or a composite of cardiovascular death or heart failure hospitalisation was the outcome of focus. In addition, secondary outcomes, i.e., cardiovascular death and heart failure hospitalisation were analysed. Individual patient data was constructed from Kaplan-Meier-extracted data; then data from all studies were combined. A mixed-effect parametric survival model with accelerated failure time was used, considering individual study as random effects and treatments as a fixed-effect. Median failure time for each regimen and hazard ratios (HR) comparing between regimens with 95% confidence intervals (CI) were then estimated from KM data. Results Cumulative incidence of the primary outcome from each regimen is displayed in Figure 1. Compared to the GDMT or ACEI+BB+MRA, BB+MRA+ARNI (HR 0.80, 95% CI 0.74–0.88), ACEI+BB+MRA+IVA (HR 0.82, 95% CI 0.75–0.90), ACEI+BB+MRA+SGLT2i (HR 0.75, 95% CI 0.68–0.82), ACEI+BB+MRA+sGC (HR 0.91, 95% CI 0.83–0.99), and ACEI+BB+MRA+OMM (HR 0.92, 95% CI 0.86–0.99) showed superior benefits. However, ACEI+BB (HR 0.68, 95% CI 0.59–0.79) and ACEI+BB+ARB (HR 0.81, 95% CI 0.67–0.98) were both statistically significantly inferior to the GDMT. The treatment combination of ACEI+BB+MRA+SGLT2i showed the highest risk reduction of 25%. More details are provided in Figure 2. The analysis of secondary outcomes showed a corresponding trend with ACEI+BB+MRA+SGLT2i combination reducing the risk of cardiovascular death by 25% (HR 0.75, 95% CI 0.68–0.82) and heart failure hospitalisation by 25% (HR 0.75, 95% CI 0.68–0.82) versus the GDMT. Conclusion The network MA showed that the SGT2i is currently the best additional drug to the GDMT in the treatment of HFrEF. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Faculty of Medicine Ramathibodi Hospital, Mahidol University