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Sacubitril-valsartan in the real world: From theory to clinical practice
Uso do Sacubitril/Valsartan no “mundo real”: da teoria à prática clínica
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"tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "491" "paginaFinal" => "496" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Será a coorte do PARADIGM-HF representativa da população do mundo real de doentes com insuficiência cardíaca?" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 801 "Ancho" => 2170 "Tamanyo" => 59969 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of patients according to number of unfulfilled eligibility criteria (A) and number of ineligibility criteria present (B) for treatment with sacubitril/valsartan according to PARADIGM-HF.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gustavo Rodrigues, António Tralhão, Carlos Aguiar, Pedro Freitas, António Ventosa, Miguel Mendes" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Gustavo" "apellidos" => "Rodrigues" ] 1 => array:2 [ "nombre" => "António" "apellidos" => "Tralhão" ] 2 => array:2 [ "nombre" => "Carlos" "apellidos" => "Aguiar" ] 3 => array:2 [ "nombre" => "Pedro" "apellidos" => "Freitas" ] 4 => array:2 [ "nombre" => "António" "apellidos" => "Ventosa" ] 5 => array:2 [ "nombre" => "Miguel" "apellidos" => "Mendes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255117302068" "doi" => "10.1016/j.repc.2017.09.023" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117302068?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918302046?idApp=UINPBA00004E" "url" => "/21742049/0000003700000006/v3_201807150625/S2174204918302046/v3_201807150625/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Sacubitril-valsartan in the real world: From theory to clinical practice" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "497" "paginaFinal" => "498" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Ricardo Fontes-Carvalho" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Ricardo" "apellidos" => "Fontes-Carvalho" "email" => array:1 [ 0 => "fontes.carvalho@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Cardiologia, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Fisiologia e Cirurgia Cardiotoracia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Uso do Sacubitril/Valsartan no “mundo real”: da teoria à prática clínica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">“In theory, theory and practice are the same. In practice, they are not.” – Albert Einstein</p></span></p><p id="par0010" class="elsevierStylePara elsevierViewall">Heart failure (HF) is considered the new cardiovascular epidemic of the 21st century, in view of its increasing prevalence, high mortality and enormous costs.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> In Portugal, HF is a major public health problem for which local and national measures are urgently needed in order to change how HF-related healthcare is currently organized.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Pharmacological treatment for heart failure with reduced ejection fraction (HFrEF) is based on careful titration of disease-modifying drugs, such as angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), beta-blockers and aldosterone antagonists.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> Recently, the PARADIGM-HF study showed that the use of sacubitril-valsartan reduced the risk of cardiovascular events by a further 20%<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> compared to ACE inhibitors and that this new strategy of neurohumoral modulation, instead of merely inhibition, increased survival by one to two years in patients with HFrEF.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Given the good results of the PARADIGM-HF study, the use of sacubitril-valsartan has been included in the European Society of Cardiology guidelines as a class IB recommendation in patients who remain symptomatic despite optimal treatment.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> The latest American guidelines for HF treatment have gone even further, recommending that patients in New York Heart Association (NYHA) class II or III who tolerate an ACE inhibitor or ARB be switched to sacubitril-valsartan to further reduce the risk of HF-related morbidity and mortality.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">However, despite the abundance of evidence and the recommendations in the guidelines, uptake of sacubitril-valsartan in the real world has been disappointingly slow.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> There are various reasons for this mismatch between theory (the guidelines) and clinical practice, one of which is that patients included in clinical trials may not be representative of the real-world population. In a study examining this question by Rodrigues et al.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> published in this issue of the <span class="elsevierStyleItalic">Journal</span>, only one in four patients with HFrEF followed in the HF clinic of a Portuguese tertiary hospital met the inclusion criteria of the PARADIGM-HF trial. Similarly, a study investigating the same issue that analyzed over 6000 consecutive patients referred to an HF clinic in the UK showed that only 21% fulfilled the PARADIGM-HF criteria,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> although this proportion increased to 60% if the need to reach the maximum ACE inhibitor/ARB doses was ignored. These findings reveal that in many HF patients doses of ACE inhibitors/ARBs are not titrated to the maximum recommended, either because of the presence of hypotension, renal failure or other comorbidities, or due to clinical inertia in titrating drug doses in HF.</p><p id="par0030" class="elsevierStylePara elsevierViewall">It is thus important to discuss whether titrating drugs up to the maximum dose should be mandatory before considering initiating sacubitril-valsartan. In the PARADIGM-HF trial, the benefits of the latter drug were consistent, regardless of dose or background therapy.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> In addition, around 40% of patients had to have their enalapril dose reduced during the trial, and treatment benefits were similar in these individuals.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> Thus, since the survival benefits of sacubitril-valsartan exceed those of an increase in ACE inhibitor/ARB dose, even patients taking submaximal doses of ACE inhibitors or ARBs should be switched to equivalent doses of sacubitril-valsartan.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, the introduction of sacubitril-valsartan is undeniably an advance in the treatment of HFrEF.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> It is indicated as a replacement for ACE inhibitors/ARBs in HF patients with ejection fraction <40% and in NYHA class II-III. In HF, delay in starting disease-modifying treatment is associated with a significant increase in mortality.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">14,15</span></a> Therefore, in the knowledge that (especially in medicine) theory and practice, as Einstein pointed out, are often not the same, the success of HF treatment will depend on whether the best scientific evidence is applied in real-world clinical practice.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fontes-Carvalho R. Uso do Sacubitril/Valsartan no “mundo real”: da teoria à prática clínica. Rev Port Cardiol. 2018;37:497–498.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heart failure in numbers: estimates for the 21st century in Portugal" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Fonseca" 1 => "D. Brás" 2 => "I. Araújo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2017.11.010" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2018" "volumen" => "37" "paginaInicial" => "97" "paginaFinal" => "104" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29325804" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0085" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus document on improvement of heart failure treatment in Portugal" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Fonseca" 1 => "D. Brito" 2 => "R. Cernadas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2017.09.012" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2017" "volumen" => "36" "paginaInicial" => "1" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29122436" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0090" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Ponikowski" 1 => "A.A. Voors" 2 => "S.D. Anker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehw128" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2016" "volumen" => "37" "paginaInicial" => "2129" "paginaFinal" => "2200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27206819" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0095" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Angiotensin-neprilysin inhibition versus enalapril in heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.J.V. McMurray" 1 => "M. Packer" 2 => "A.S. Desai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1409077" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2014" "volumen" => "371" "paginaInicial" => "993" "paginaFinal" => "1004" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25176015" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0100" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estimating the long-term treatment benefits of sacubitril-valsartan" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B. Claggett" 1 => "M. Packer" 2 => "J.J. McMurray" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMc1509753" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2015" "volumen" => "373" "paginaInicial" => "2289" "paginaFinal" => "2290" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26630151" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0105" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.W. Yancy" 1 => "M. Jessup" 2 => "B. Bozkurt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2017.04.025" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2017" "volumen" => "70" "paginaInicial" => "776" "paginaFinal" => "803" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28461007" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0110" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early adoption of sacubitril/valsartan for patients with heart failure with reduced ejection fraction: insights from Get With the Guidelines-Heart Failure (GWTG-HF)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. Luo" 1 => "G.C. Fonarow" 2 => "S.J. Lippmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jchf.2016.12.018" "Revista" => array:6 [ "tituloSerie" => "JACC Heart Fail" "fecha" => "2017" "volumen" => "5" "paginaInicial" => "305" "paginaFinal" => "309" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28359417" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0115" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Será a coorte do PARADIGM-HF representativa da população do mundo real de doentes com insuficiência cardíaca?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Rodrigues" 1 => "A. Tralhão" 2 => "C. Aguiar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2017.09.023" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2018" "volumen" => "37" "paginaInicial" => "491" "paginaFinal" => "496" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29779951" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0120" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What proportion of patients with chronic heart failure are eligible for sacubitril-valsartan?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Pellicori" 1 => "A. Urbinati" 2 => "P. Shah" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ejhf.788" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2017" "volumen" => "19" "paginaInicial" => "768" "paginaFinal" => "778" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28244205" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0125" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "pii:e003212" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of sacubitril/valsartan in the PARADIGM-HF trial (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) according to background therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. Okumura" 1 => "P.S. Jhund" 2 => "J. Gong" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Circ Heart Fail" "fecha" => "2016" "volumen" => "9" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0130" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of sacubitril/valsartan vs. enalapril at lower than target doses in heart failure with reduced ejection fraction: the PARADIGM-HF trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "O. Vardeny" 1 => "B. Claggett" 2 => "M. Packer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ejhf.580" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2016" "volumen" => "18" "paginaInicial" => "1228" "paginaFinal" => "1234" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27283779" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0135" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "." "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Love of angiotensin-converting enzyme inhibitors in the time of cholera" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Packer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jchf.2015.12.011" "Revista" => array:3 [ "tituloSerie" => "JACC Heart Fail" "fecha" => "2016" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26874379" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0140" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sacubitril/valsartan: an important piece in the therapeutic puzzle of heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Marques da Silva" 1 => "C. Aguiar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2016.11.013" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2017" "volumen" => "36" "paginaInicial" => "655" "paginaFinal" => "668" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28844335" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0145" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The mortality risk of deferring optimal medical therapy in heart failure: a systematic comparison against norms for surgical consent and patient information leaflets" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Zaman" 1 => "S.S. Zaman" 2 => "T. Scholtes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ejhf.838" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2017" "volumen" => "19" "paginaInicial" => "1401" "paginaFinal" => "1409" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28597606" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0150" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Potential mortality reduction with optimal implementation of angiotensin receptor neprilysin inhibitor therapy in heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.C. Fonarow" 1 => "A.F. Hernandez" 2 => "S.D. Solomon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamacardio.2016.1724" "Revista" => array:6 [ "tituloSerie" => "JAMA Cardiol" "fecha" => "2016" "volumen" => "1" "paginaInicial" => "714" "paginaFinal" => "717" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27437874" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003700000006/v3_201807150625/S2174204918301557/v3_201807150625/en/main.assets" "Apartado" => array:4 [ "identificador" => "9917" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003700000006/v3_201807150625/S2174204918301557/v3_201807150625/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918301557?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 6 | 11 |
| 2024 October | 42 | 36 | 78 |
| 2024 September | 44 | 23 | 67 |
| 2024 August | 40 | 34 | 74 |
| 2024 July | 35 | 28 | 63 |
| 2024 June | 31 | 31 | 62 |
| 2024 May | 28 | 18 | 46 |
| 2024 April | 32 | 22 | 54 |
| 2024 March | 49 | 28 | 77 |
| 2024 February | 28 | 26 | 54 |
| 2024 January | 30 | 23 | 53 |
| 2023 December | 21 | 22 | 43 |
| 2023 November | 34 | 24 | 58 |
| 2023 October | 14 | 12 | 26 |
| 2023 September | 19 | 19 | 38 |
| 2023 August | 23 | 18 | 41 |
| 2023 July | 12 | 10 | 22 |
| 2023 June | 23 | 10 | 33 |
| 2023 May | 39 | 30 | 69 |
| 2023 April | 32 | 6 | 38 |
| 2023 March | 75 | 25 | 100 |
| 2023 February | 52 | 28 | 80 |
| 2023 January | 19 | 16 | 35 |
| 2022 December | 50 | 26 | 76 |
| 2022 November | 76 | 30 | 106 |
| 2022 October | 46 | 24 | 70 |
| 2022 September | 24 | 30 | 54 |
| 2022 August | 26 | 33 | 59 |
| 2022 July | 40 | 46 | 86 |
| 2022 June | 26 | 29 | 55 |
| 2022 May | 23 | 31 | 54 |
| 2022 April | 32 | 29 | 61 |
| 2022 March | 37 | 44 | 81 |
| 2022 February | 34 | 39 | 73 |
| 2022 January | 25 | 33 | 58 |
| 2021 December | 18 | 27 | 45 |
| 2021 November | 44 | 34 | 78 |
| 2021 October | 34 | 49 | 83 |
| 2021 September | 38 | 27 | 65 |
| 2021 August | 53 | 34 | 87 |
| 2021 July | 25 | 22 | 47 |
| 2021 June | 37 | 22 | 59 |
| 2021 May | 46 | 46 | 92 |
| 2021 April | 50 | 49 | 99 |
| 2021 March | 79 | 29 | 108 |
| 2021 February | 79 | 24 | 103 |
| 2021 January | 59 | 19 | 78 |
| 2020 December | 57 | 27 | 84 |
| 2020 November | 47 | 14 | 61 |
| 2020 October | 29 | 17 | 46 |
| 2020 September | 87 | 21 | 108 |
| 2020 August | 40 | 11 | 51 |
| 2020 July | 62 | 19 | 81 |
| 2020 June | 68 | 17 | 85 |
| 2020 May | 59 | 13 | 72 |
| 2020 April | 50 | 12 | 62 |
| 2020 March | 94 | 21 | 115 |
| 2020 February | 171 | 30 | 201 |
| 2020 January | 65 | 12 | 77 |
| 2019 December | 85 | 16 | 101 |
| 2019 November | 84 | 18 | 102 |
| 2019 October | 60 | 12 | 72 |
| 2019 September | 99 | 19 | 118 |
| 2019 August | 59 | 14 | 73 |
| 2019 July | 72 | 17 | 89 |
| 2019 June | 46 | 22 | 68 |
| 2019 May | 64 | 18 | 82 |
| 2019 April | 43 | 21 | 64 |
| 2019 March | 61 | 24 | 85 |
| 2019 February | 80 | 13 | 93 |
| 2019 January | 45 | 8 | 53 |
| 2018 December | 76 | 21 | 97 |
| 2018 November | 109 | 13 | 122 |
| 2018 October | 237 | 26 | 263 |
| 2018 September | 66 | 20 | 86 |
| 2018 August | 59 | 44 | 103 |
| 2018 July | 94 | 42 | 136 |
| 2018 June | 59 | 46 | 105 |
| 2018 May | 7 | 6 | 13 |
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