Background
We sought to compare cardiovascular outcomes, renal function, and diuresis in patients receiving standard diuretic therapy for acute heart failure (AHF) with or without the addition of SGLT2i.
Methods and results
Systematic search of three electronic databases identified nine eligible randomized controlled trials involving 2,824 patients. The addition of SGLT2i to conventional therapy for AHF reduced all-cause death (odds ratio [OR] 0.75; 95% CI 0.56–0.99;
p
= 0.049), readmissions for heart failure (HF) (OR 0.54; 95% CI 0.44–0.66;
p
< 0.001), and the composite of cardiovascular death and readmissions for HF (hazard ratio 0.71; 95% CI 0.60–0.84;
p
< 0.001). Furthermore, SGLT2i increased mean daily urinary output in liters (mean difference [MD] 0.45; 95% CI 0.03–0.87;
p
= 0.035) and decreased mean daily doses of loop diuretics in mg of furosemide equivalent (MD -34.90; 95% CI [− 52.58, − 17.21];
p
< 0.001) without increasing the incidence worsening renal function (OR 0.75; 95% CI 0.43–1.29;
p
= 0.290).
Conclusion
SGLT2i addition to conventional diuretic therapy reduced all-cause death, readmissions for HF, and the composite of cardiovascular death or readmissions for HF. Moreover, SGLT2i was associated with a higher volume of diuresis with a lower dose of loop diuretics.
Graphical abstract
Supplementary Information
The online version contains supplementary material available at 10.1007/s00392-022-02148-2.
Background
The efficacy and safety of percutaneous coronary interventions (PCI) relative to coronary artery bypass grafting (CABG) in patients with diabetes and unprotected left main coronary artery disease (LMCAD) are not well established.
Objectives
To perform a meta‐analysis evaluating the long‐term outcomes after PCI with drug‐eluting stents (DES), as compared with CABG, in patients with diabetes and unprotected LMCAD.
Methods
MEDLINE, Cochrane, and Embase were searched for randomized controlled trials (RCTs) that reported outcomes after PCI with DES versus CABG in unprotected LMCAD among patients with diabetes. To evaluate the long‐term effects of these interventions, we restricted this analysis to studies with a minimum follow‐up period of 3 years. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled with a random‐effects model. Quality assessment and risk of bias were performed according to Cochrane recommendations.
Results
Four RCTs with a total of 1080 patients were included, 553 (51.2%) of whom underwent PCI. There was no difference for individual outcomes of all‐cause mortality (RR: 1.21; 95% CI: 0.86–1.71; p = .27; I2 = 28%), cardiovascular death (RR 1.29; 95% CI: 0.76–2.18; p = .34; I2 = 0%), or myocardial infarction (MI) (RR: 0.94; 95% CI: 0.61–1.45; p = .79; I2 = 0%). However, the risk of stroke was reduced with PCI relative to CABG (RR: 0.41; 95% CI: 0.18–0.94; p = .04; I2 = 0%), whereas the risk of any repeat revascularization was higher in the PCI group (RR: 1.99; 95% CI: 1.44–2.75; p < .001; I2 = 0%). The risk of the composite outcome of all‐cause mortality, MI, stroke, or repeat revascularization was higher after PCI compared with CABG (RR: 1.30; 95% CI: 1.09–1.56; p = .004; I2 = 0%).
Conclusion
In this meta‐analysis with more than 1000 patients with diabetes and unprotected LMCAD followed for a minimum of 3 years, the incidence of repeat revascularization was higher among those treated with PCI, whereas the risk of stroke was higher in patients treated with CABG.
The COVID-19 pandemic affected almost all aspects of our lives, including the Education sector and the way of teaching and learning. In March 2020, health authorities in Brazil have imposed social isolation and the interruption of on-site activities in schools and universities. In this context, the Federal University of Minas Gerais (UFMG), one of the largest universities in Brazil and Latin America, developed the Emergency Remote Learning (ERL) that allowed the return of classes in an online format and supported students to obtain access to equipment and Internet network. Within this new perspective, the Undergraduate Teaching Assistant (UTA) program of the Department of Physiology and Biophysics (DFIB) has been explored strategies to minimize the impact of the absence of face-to-face classes. Using different available tools in online platforms and social media, such as, Microsoft Teams, Youtube animated video classes, and Instagram, UTA program assisted more than 500 undergraduate students and strongly supported professors during ERL. In just over a year, our video classes on Youtube Channel reached about 40k views. Most of the students reported their questions were fully and quickly solved by UTA program. Collectively, our results indicate that the strategies implemented by the UTA program helped the undergraduate students and professors to adapt to a remote learning format, keeping the quality of the education.
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