Browsing by Author "Lanas, Fernando"

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    Características basales, manejo de terapias antitrombóticas y pronóstico de pacientes chilenos con FA no valvular. Lecciones del Registro GARFIELD AF en Chile
    (2017) Corbalan, Ramon; Conejeros, Carlos; Rey, Carlos; Stockins, Benjamin; Egers, German; Astudillo, Carlos; Lanas, Fernando; Potthoff, Sergio; Houzvic, Cesar; Montecinos, Humberto; Charme, Gustavo; Bugueno, Claudio; Aguilar, Juan; Ariagada, German; Marin, Patricio; Larico, Martin; Representacion Grp GARFIELD AF
    Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with high rates of death, ischemic stroke and systemic embolism (SE). There is scarce information about clinical characteristics and use of antithrombotic therapies in Chilean patients with non-valvular AF. Aim: To describe the characteristics and 1-year outcomes of patients with recently diagnosed AF recruited in Chile into the prospective global GARFIELD-AF registry. Material and Methods: Between 2011-2016, we prospectively registered information of 971 patients recruited at 15 centers, 85% of them from the public system and 15% from the private sector. Demographics, clinical characteristics and use of antithrombotic therapies were recorded for all patients. Adverse clinical outcomes were analyzed in 711 patients with 1-year follow-up. Results: The mean age was 71.5 years (66-79), 50% were men. Mean CHAD2S2 Vasc and HAS BLED scores for stroke risk were 3.3 (2.0-4.0) and 1.5 (1.0-2.0) respectively. Oral anticoagulants were prescribed in 82% of patients. Seventy percent received Vitamin K antagonists, 10% novel direct anticoagulants or antiplatelet therapy and only 8% did not receive any antithrombotic therapy. Mean time in optimal therapeutic range (an international normalized ratio of 2 to 3), was achieved in only 40.7% (23.0-54.8) of patients receiving Vitamin K antagonists. One year rates of death, stroke/systemic embolism and bleeding were 4.75 (3.36-6.71), 2.40 (1.47-3.92) and 1.64% (0.91-2.97) per 100 person-years. Ischemic stroke occurred in 1.8% and hemorrhagic stroke in 0.8% of patients at 1-year of follow up. Conclusions: Although the use of vitamin K antagonists at baseline was high, the mean time in optimal therapeutic range was low. Mortality and stroke rates are higher than those reported in other contemporary registries.
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    Cost-Effectiveness of Exercise-Based Cardiac Rehabilitation in Chilean Patients Surviving Acute Coronary Syndrome
    (2019) Seron, Pamela; Gaete, Monica; Oliveros, Maria-Jose; Roman, Claudia; Lanas, Fernando; Velasquez, Monica; Reveco, Roberto; Bustos, Luis; Rojas, Ruben
    Purpose: To assess the cost-effectiveness of 3 models of exercise-based cardiac rehabilitation (CR) compared with standard care in survivors of acute coronary syndrome (ACS) within the public health system in Chile.
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    Hybrid Cardiac Rehabilitation Program in a Low-Resource Setting
    (2024) Seron, Pamela; Oliveros, Maria Jose; Marzuca-Nassr, Gabriel Nasri; Morales, Gladys; Roman, Claudia; Munoz, Sergio Raul; Galvez, Manuel; Latin, Gonzalo; Marileo, Tania; Molina, Juan Pablo; Navarro, Rocio; Sepúlveda Varela, Pablo Andrés; Lanas, Fernando; Saavedra, Nicolas; Ulloa, Constanza; Grace, Sherry L.
    IMPORTANCE While effective, cardiovascular rehabilitation (CR) as traditionally delivered is not well implemented in lower-resource settings. OBJECTIVE To test the noninferiority of hybrid CR compared with traditional CR in terms of cardiovascular events. DESIGN, SETTING, AND PARTICIPANTS This pragmatic, multicenter, parallel arm, open-label randomized clinical trial (the Hybrid Cardiac Rehabilitation Trial [HYCARET]) with blinded outcome assessment was conducted at 6 referral centers in Chile. Adults aged 18 years or older who had a cardiovascular event or procedure, no contraindications to exercise, and access to a mobile telephone were eligible and recruited between April 1, 2019, and March 15, 2020, with follow-up until July 29, 2021. INTERVENTIONS Participants were randomized 1:1 in permuted blocks to the experimental arm, which received 10 center-based supervised exercise sessions plus counseling in 4 to 6 weeks and then were supported at home via telephone calls and text messages through weeks 8 to 12, or the control arm, which received the standard CR of 18 to 22 sessions with exercises and education in 8 to 12 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was cardiovascular events or mortality. Secondary outcomes were quality of life, return to work, and lifestyle behaviors measured with validated questionnaires; muscle strength and functional capacity, measured through physical tests; and program adherence and exercise-related adverse events, assessed using checklists. RESULTS A total of 191 participants were included (mean [SD] age, 58.74 [9.80] years; 145 [75.92%] male); 93 were assigned to hybrid CR and 98 to standard CR. At 1 year, events had occurred in 5 unique participants in the hybrid CR group (5.38%) and 9 in the standard CR group (9.18%). In the intention-to-treat analysis, the hybrid CR group had 3.80% (95% CI, -11.13% to 3.52%) fewer cardiovascular events than the standard CR group, and relative risk was 0.59 (95% CI, 0.20-1.68) for the primary outcome. In the per-protocol analysis at different levels of adherence to the intervention, all 95% CIs crossed the noninferiority boundary (eg, 20% adherence: absolute risk difference, - 0.35% [95% CI, -7.56% to 6.85%]; 80% adherence: absolute risk difference, 3.30% [95% CI, - 3.70% to 10.31%]). No between-group differences were found for secondary outcomes except adherence to supervised CR sessions (79.14% [736 of 930 supervised sessions] in the hybrid CR group vs 61.46% [1201 of 1954 sessions] in the standard CR group). CONCLUSIONS AND RELEVANCE The results suggest that a hybrid CR program is noninferior to standard center-based CR in a low-resource setting, primarily in terms of recurrent cardiovascular events and potentially in terms of intermediate outcomes. Hybrid CR may induce superior adherence to supervised exercise. Clinical factors and patient preferences should inform CR model allocation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03881150
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    Hybrid cardiac rehabilitation trial (HYCARET): protocol of a randomised, multicentre, non-inferiority trial in South America
    (2019) Seron, Pamela; Oliveros, Maria J.; Marzuca-Nassr, Gabriel N.; Lanas, Fernando; Morales, Gladys; Roman, Claudia; Munoz, Sergio R.; Saavedra, Nicolas; Grace, Sherry L.
    Introduction Cardiac rehabilitation (CR) programmes are well established, and their effectiveness and cost-effectiveness are proven. In spite of this, CR remains underused, especially in lower-resource settings such as Latin America. There is an urgent need to create more accessible CR delivery models to reach all patients in need. This trial aims to evaluate if the prevention of recurrent cardiovascular events is not inferior in a hybrid CR programme compared with a standard programme.
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    In-hospital mortality after ST-segment elevation myocardial infarction according to reperfusion therapy
    (2008) Prieto, Juan Carlos; Sanhueza, Consuelo; Martinez, Nicolas; Nazzala, Carolina; Corbalan, Ramon; Cavada, Gabriel; Lanas, Fernando; Bartolucci, Jorge; Campos, Pabla
    Background: Primary angioplasty is considered the best repefusion therapy in The treatment of ST-segment elevation))myocardial infarction (STEMI). However, thrombolysis the reperfusion, method most commonly used, due to its wide availability reduced costs and case of administration. Aim To compare in-hospital mortality, in STEMI patients according to repefusion therapy. Material and Methods. Patients admitted to Chilean hospitals participating in the GEMI network,from. 2001 to 2005, with STEMI were included. They were divided in three groups: a) treated with thrombolytics, b) treated with primary angioplasty, c) without reperfusion procedure. In-hospital mortality according to gender, was analized in each group, using a logistic regression method, to assess risk factors associated with mortality. Results: We included 3,255 patients. Global mortality was 9.9% (75% in men and 16.7% in women, p < 0.001). Mortality in patients treated with thrombolytics, was 10.2% (76% in men and 18.7% in women, p < 0.01). The figure for patients treated with primary angioplasty, was 4.7% (2.5% in men and 13% in women, p < 0.01), and in patients without reperfusion, was 11.6% (9.8% in men and in 15.4% women, p < 0.01). In each group women were older, had a higher prevalence of hypertension and a higher percentage of Killip 3-4 infarctions. Logistic regression showed that angioplasty) compared with no repefusion, was associated with a reduced mortality only in men. The use of thrombolytics in women was associated with a higher mortality. Conclusions: Primary angioplasty was the reperfusion therapy associated to the lower mortality in STEMI. Use of thrombolytics in women was associated with a higher mortality rate than in non reperfused women