Javier Mariani

Background: HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative. This paper presents Phase 3 of HEARTS 2.0, an evidence-informed process to prioritize clinical and health-system interventions to support the operationalization of integrated cardiovascular, kidney, and metabolic (CKM) care in primary health care (PHC) and to inform the update of the HEARTS Clinical Pathway. CKM conditions frequently coexist, sharing common risk factors and pathophysiological mechanisms that exacerbate cardiovascular disease burden. Despite their overlap, clinical practice often remains siloed due to condition-specific guidelines, and its integration remains limited. To prioritize evidence-informed clinical and health-system interventions that support the operationalization of integrated CKM care within PHC and inform the update of the HEARTS Clinical Pathway. Methods: Building on previous phases of HEARTS 2.0, a multidisciplinary panel evaluated 45 candidate interventions in different areas. The selection process utilized structured evidence appraisal, Evidence-to-Decision frameworks, and a modified RAND/UCLA appropriateness method involving anonymized rating rounds. Results: A total of 38 interventions were prioritized for implementation. Although hypertension management remains the primary entry point, the resulting framework integrates early detection of diabetes and chronic kidney disease, lifestyle interventions, risk-based combination pharmacotherapy, task-sharing, and longitudinal follow-up. Conclusions: By translating dispersed guideline recommendations into implementable interventions, Phase 3 of HEARTS 2.0 provides an evidence-informed basis for advancing integrated CKM care at scale in PHC and guiding the forthcoming update of the HEARTS Clinical Pathway. The resulting framework offers a flexible, scalable approach for countries confronting similar epidemiological and health system challenges.

Background: Human papillomavirus (HPV) is a common sexually transmitted infection, with higher prevalence among men who have sex with men (MSM) and people who self-identify as transgender women (PSTGW). High-risk genotypes (hrHPV) carry oncogenic potential. This study assessed hrHPV prevalence in penile samples from MSM and PSTGW in Buenos Aires, Argentina. Methods: A cross-sectional analysis of baseline data from a longitudinal study was conducted. Participants aged ≥18 were recruited from an HIV prevention center. Penile samples, collected via standardized sandpaper exfoliation, were analyzed using the AmpFire HPV Genotyping Assay for 15 genotypes. Logistic regression models identified factors associated with HPV. Results: Among 298 samples from 300 participants (256 MSM, 44 PSTGW), HIV prevalence was 27%. Penile hrHPV prevalence was 31%, with no significant difference between MSM and PSTGW (p = 0.465). Frequent genotypes included HPV-33, HPV-53 and HPV-16 (6.3%, 5.3%, and 4.6% respectively). People with HIV (PWH) showed higher hrHPV prevalence than HIV negative individuals (41% vs 27%, p = 0.023), more infections with ≥3 genotypes (15% vs 4%, p < 0.001), and higher nonavalent vaccine genotype detection (30% vs 15%, p = 0.005). Multivariate analysis associated hrHPV infection with being PWH (aOR = 1.99), >5 sexual partners in the past month (aOR = 1.77), and lifetime sex work (aOR = 2.68). Conclusions: Penile hrHPV was highly prevalent among MSM and PSTGW, particularly among PWH and those with a history of sex work. Low vaccination rate and high prevalence of vaccine-preventable genotypes underscore the need to expand HPV vaccination in these populations.

ObjetivosEvaluar mediante un metaanálisis los efectos de la reperfusión tardía en el IAM (hipótesis de la arteria abierta) sobre la morbimortalidad y la fracción de eyección (Fey). Material y métodosSe incluyeron estudios aleatorizados controlados (EAC) que compararan angioplastia (ATC) con tratamiento médico (TM) en pacientes con infarto agudo de miocardio (IAM) que permanecieran con la arteria ocluida > 12 horas, con un seguimiento > 3 meses. Se realizaron búsquedas electrónicas y en listas de referencias. ResultadosOcho EAC, que sumaron 2.972 pacientes, cumplieron los criterios de inclusión; los estudios incluyeron entre 30 y 2.166 pacientes (media: 77). El intervalo entre el IAM y la ATC fue de 25 horas a 26,3 días (media: 8,3 días). En forma global se detectó una tendencia a la reducción del riesgo de muerte [RR 0,73 (IC 95% 0,46-1,16)] y al incremento del riesgo de IAM [RR 1,15 (IC 95% 0,76-1,72)]. Hubo una tendencia a la reducción en las internaciones por IC con la ATC con un RR de 0,56 (0,26-1,21) y una reducción significativa de procedimientos de revascularización con un RR de 0,82 (0,70-0,97). La Fey en el seguimiento fue 2,39 puntos mayor en el grupo ATC (-0,06-4,84). Sin embargo, la evaluación de los datos según la calidad de los estudios demuestra que el beneficio sobre la mortalidad se concentra en los EAC de menor calidad [0,50 (0,25-0,99)], mientras que no existe tal beneficio en los EAC de mayor calidad [0,89 (0,53-1,51)]. No hubo heterogeneidad significativa, excepto en los efectos sobre la fracción de eyección (p de heterogeneidad = 0,03); el nivel de inconsistencia general fue moderado. Existen evidencias de sesgo de publicación. Conclusiones Sobre la base de estos resultados, el metaanálisis indica que efectuar una angioplastia tar- día en vasos ocluidos en el infarto no aporta beneficios sobre la morbimortalidad. Los resultados entusiastas de los primeros ensayos de pequeñas dimensiones pueden ser atribuidos a sesgos de publicación y a déficits en el diseño. Se registra un discreto incremento en la Fey con la intervención que no se tradujo en beneficios clínicos en esta población de bajo riesgo, aunque sería interesante su estudio en pacientes con compromiso significativo de la función ventricular.

Objective. In low- and middle-income countries, heart failure (HF) is the leading cause of death and disability. Materials and methods. A feasibility study was conducted to assess the fidelity, reach, and adoption of an educational program led by non-medical staff to improve outpatient care for patients hospitalized with HF in the local public health system. Results. Thirty patients were included, with a mean age of 55.3 years (63.3% male). A total of 97.3% of planned home visits and 90% of scheduled phone calls were completed. Counselling modules were delivered during 90.4% of home visits, with no significant challenges reported during implementation. At the end of follow-up, there was a trend towards improved lifestyle habits, a reduction in mean heart rate (78.0 to 68.3 beats per minute; p = 0.016), a decrease in the proportion of patients in NYHA functional class III (20% to 7.4%; p = 0.041), and a slight reduction in mean body mass index (29.5 vs. 28.9; p = 0.042). Conclusions. A home-based educational program, designed to optimize outpatient management of heart failure and led by non-medical healthcare personnel, was well-received and demonstrated feasibility for implementation in low-income patients relying solely on the Argentine public health system.

How to cite this article: Tajer C, Grecco K, Fiorini N, De Abreu M, Mariani J. MULTISTARS AMI. A New Constellation or Just Stardust? Rev Argent Cardiol 2024;92:151-54. http://dx.doi.org/10.7775/rac.v92.i2.20749