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Connolly SJ, Karthikeyan G, Ntsekhe M, Haileamlak A, El Sayed A, El Ghamrawy A, Damasceno A, Avezum A, Dans AML, Gitura B, Hu D, Kamanzi ER, Maklady F, Fana G, Gonzalez-Hermosillo JA, Musuku J, Kazmi K, Zühlke L, Gondwe L, Ma C, Paniagua M, Ogah OS, Molefe-Baikai OJ, Lwabi P, Chillo P, Sharma SK, Cabral TTJ, Tarhuni WM, Benz A, van Eikels M, Krol A, Pattath D, Balasubramanian K, Rangarajan S, Ramasundarahettige C, Mayosi B, Yusuf S. Rivaroxaban in Rheumatic Heart Disease-Associated Atrial Fibrillation. N Engl J Med 2022; 387:978-988. [PMID: 36036525 DOI: 10.1056/nejmoa2209051] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Testing of factor Xa inhibitors for the prevention of cardiovascular events in patients with rheumatic heart disease-associated atrial fibrillation has been limited. METHODS We enrolled patients with atrial fibrillation and echocardiographically documented rheumatic heart disease who had any of the following: a CHA2DS2VASc score of at least 2 (on a scale from 0 to 9, with higher scores indicating a higher risk of stroke), a mitral-valve area of no more than 2 cm2, left atrial spontaneous echo contrast, or left atrial thrombus. Patients were randomly assigned to receive standard doses of rivaroxaban or dose-adjusted vitamin K antagonist. The primary efficacy outcome was a composite of stroke, systemic embolism, myocardial infarction, or death from vascular (cardiac or noncardiac) or unknown causes. We hypothesized that rivaroxaban therapy would be noninferior to vitamin K antagonist therapy. The primary safety outcome was major bleeding according to the International Society of Thrombosis and Hemostasis. RESULTS Of 4565 enrolled patients, 4531 were included in the final analysis. The mean age of the patients was 50.5 years, and 72.3% were women. Permanent discontinuation of trial medication was more common with rivaroxaban than with vitamin K antagonist therapy at all visits. In the intention-to-treat analysis, 560 patients in the rivaroxaban group and 446 in the vitamin K antagonist group had a primary-outcome event. Survival curves were nonproportional. The restricted mean survival time was 1599 days in the rivaroxaban group and 1675 days in the vitamin K antagonist group (difference, -76 days; 95% confidence interval [CI], -121 to -31; P<0.001). A higher incidence of death occurred in the rivaroxaban group than in the vitamin K antagonist group (restricted mean survival time, 1608 days vs. 1680 days; difference, -72 days; 95% CI, -117 to -28). No significant between-group difference in the rate of major bleeding was noted. CONCLUSIONS Among patients with rheumatic heart disease-associated atrial fibrillation, vitamin K antagonist therapy led to a lower rate of a composite of cardiovascular events or death than rivaroxaban therapy, without a higher rate of bleeding. (Funded by Bayer; INVICTUS ClinicalTrials.gov number, NCT02832544.).
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Affiliation(s)
- Stuart J Connolly
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Ganesan Karthikeyan
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Mpiko Ntsekhe
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Abraham Haileamlak
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Ahmed El Sayed
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Alaa El Ghamrawy
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Albertino Damasceno
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Alvaro Avezum
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Antonio M L Dans
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Bernard Gitura
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Dayi Hu
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Emmanuel R Kamanzi
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Fathi Maklady
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Golden Fana
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - J Antonio Gonzalez-Hermosillo
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - John Musuku
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Khawar Kazmi
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Liesl Zühlke
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Lillian Gondwe
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Changsheng Ma
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Maria Paniagua
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Okechukwu S Ogah
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Onkabetse J Molefe-Baikai
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Peter Lwabi
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Pilly Chillo
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Sanjib K Sharma
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Tantchou T J Cabral
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Wadea M Tarhuni
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Alexander Benz
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Martin van Eikels
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Amy Krol
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Divya Pattath
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Kumar Balasubramanian
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Sumathy Rangarajan
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Chinthanie Ramasundarahettige
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Bongani Mayosi
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
| | - Salim Yusuf
- From the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.J.C., A.B., A.K., D.P., K.B., S.R., C.R., S.Y.); the All India Institute of Medical Sciences, New Delhi (G.K.); the Division of Cardiology, Faculty of Health Sciences, University of Cape Town (M.N., B.M.), and the South African Medical Research Council (L.Z.) - both in Cape Town, South Africa; Jimma University Medical Center, Jimma, Ethiopia (A.H.); the University of Gazira, Wad Madani, Sudan (A.E.S.); Mahalla Heart Center, El Mahalla El Kubra (A.E.G.), and Suez Canal University Hospital, Ismailia (F.M.) - both in Egypt; the Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); the College of Medicine, University of the Philippines, Manila (A.M.L.D.); Kenyatta National Hospital, Nairobi (B.G.); the People's Hospital of Peking University (D.H.) and the Beijing Anzhen Hospital (C.M.) - both in Beijing; the University Teaching Hospital of Kigali, Kigali, Rwanda (E.R.K.); the University of Zimbabwe, College of Health Sciences, Harare (G.F.); Instituto Nacional de Cardiología Ignacio Chávez, Mexico City (J.A.G.-H.); the University Teaching Hospital, Lusaka, Zambia (J.M.); the National Institute of Cardiovascular Diseases, Karachi, Pakistan (K.K.); Kamuzu Central Hospital, Lilongwe, Malawi (L.G.); Barrio Obrero Hospital, Asuncion, Paraguay (M.P.); the Department of Medicine, University of Ibadan-College Hospital, Ibadan, Nigeria (O.S.O.); Princess Marina Hospital, University of Botswana, Gaborone (O.J.M.-B.); Uganda Heart Institute, Kampala (P.L.); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (P.C.); the B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); St. Elizabeth Catholic General Hospital, Kumbo, Cameroon (T.T.J.C.); the Department of Medicine, University of Saskatchewan, Saskatoon, the Department of Medicine, Western University, London, ON, and the Windsor Cardiac Centre, Windsor, ON - all in Canada (W.M.T.); the Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz (A.B.), and Bayer, Berlin (M.E.) - both in Germany
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Guimarães HP, Lopes RD, de Barros E Silva PGM, Liporace IL, Sampaio RO, Tarasoutchi F, Hoffmann-Filho CR, de Lemos Soares Patriota R, Leiria TLL, Lamprea D, Precoma DB, Atik FA, Silveira FS, Farias FR, Barreto DO, Almeida AP, Zilli AC, de Souza Neto JD, Cavalcante MA, Figueira FAMS, Kojima FCS, Damiani L, Santos RHN, Valeis N, Campos VB, Saraiva JFK, Fonseca FH, Pinto IM, Magalhães CC, Ferreira JFM, Alexander JH, Pavanello R, Cavalcanti AB, Berwanger O. Rivaroxaban in Patients with Atrial Fibrillation and a Bioprosthetic Mitral Valve. N Engl J Med 2020; 383:2117-2126. [PMID: 33196155 DOI: 10.1056/nejmoa2029603] [Citation(s) in RCA: 150] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The effects of rivaroxaban in patients with atrial fibrillation and a bioprosthetic mitral valve remain uncertain. METHODS In this randomized trial, we compared rivaroxaban (20 mg once daily) with dose-adjusted warfarin (target international normalized ratio, 2.0 to 3.0) in patients with atrial fibrillation and a bioprosthetic mitral valve. The primary outcome was a composite of death, major cardiovascular events (stroke, transient ischemic attack, systemic embolism, valve thrombosis, or hospitalization for heart failure), or major bleeding at 12 months. RESULTS A total of 1005 patients were enrolled at 49 sites in Brazil. A primary-outcome event occurred at a mean of 347.5 days in the rivaroxaban group and 340.1 days in the warfarin group (difference calculated as restricted mean survival time, 7.4 days; 95% confidence interval [CI], -1.4 to 16.3; P<0.001 for noninferiority). Death from cardiovascular causes or thromboembolic events occurred in 17 patients (3.4%) in the rivaroxaban group and in 26 (5.1%) in the warfarin group (hazard ratio, 0.65; 95% CI, 0.35 to 1.20). The incidence of stroke was 0.6% in the rivaroxaban group and 2.4% in the warfarin group (hazard ratio, 0.25; 95% CI, 0.07 to 0.88). Major bleeding occurred in 7 patients (1.4%) in the rivaroxaban group and in 13 (2.6%) in the warfarin group (hazard ratio, 0.54; 95% CI, 0.21 to 1.35). The frequency of other serious adverse events was similar in the two groups. CONCLUSIONS In patients with atrial fibrillation and a bioprosthetic mitral valve, rivaroxaban was noninferior to warfarin with respect to the mean time until the primary outcome of death, major cardiovascular events, or major bleeding at 12 months. (Funded by PROADI-SUS and Bayer; RIVER ClinicalTrials.gov number, NCT02303795.).
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Affiliation(s)
- Helio P Guimarães
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Renato D Lopes
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Pedro G M de Barros E Silva
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Idelzuita L Liporace
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Roney O Sampaio
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Flávio Tarasoutchi
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Conrado R Hoffmann-Filho
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Rodrigo de Lemos Soares Patriota
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Tiago L L Leiria
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Diana Lamprea
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Dalton B Precoma
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Fernando A Atik
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Fabio S Silveira
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Fabio R Farias
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Diogo O Barreto
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Adail P Almeida
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Alexandre C Zilli
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - João D de Souza Neto
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Margaret A Cavalcante
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Fernando A M S Figueira
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Flávia C S Kojima
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Lucas Damiani
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Renato H N Santos
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Nanci Valeis
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Viviane B Campos
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Jose F K Saraiva
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Francisco H Fonseca
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Ibraim M Pinto
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Carlos C Magalhães
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Joao F M Ferreira
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - John H Alexander
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Ricardo Pavanello
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Alexandre B Cavalcanti
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
| | - Otavio Berwanger
- From the HCor Research Institute (H.P.G., P.G.M.B.S., F.C.S.K., L.D., R.H.N.S., N.V., V.B.C., R.P., A.B.C., O.B.), Instituto Dante Pazzanese de Cardiologia (I.L.L.), Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (R.O.S., F.T.), Sociedade de Cardiologia do Estado de São Paulo (J.F.K.S., F.H.F., I.M.P., C.C.M., J.F.M.F., R.P., O.B.), and Hospital Israelita Albert Einstein (O.B.), São Paulo, Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.-F.), Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho (R.L.S.P.), Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre (T.L.L.L.), Pronto Socorro Cardiológico Prof. Luiz Tavares, Procape (D.L.), Instituto de Medicina Integral Prof. Fernando Figueira (F.A.M.S.F.), Recife, Sociedade Hospitalar Angelina Caron, Campina Grande do Sul (D.B.P.), Instituto de Cardiologia do Distrito Federal, Brasília (F.A.A.), Centro de Pesquisa Clínica do Coração, Aracajú (F.S.S.), Quanta Diagnóstico e Terapia, Curitiba (F.R.F.), Hospital Evangélico de Vila Velha, Vila Velha (D.O.B.), Unidade Médico Cirúrgica-Unimec, Vitória da Conquista (A.P.A.), Hospital de Caridade São Vicente de Paulo, Jundiaí (A.C.Z.), Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (J.D.S.N.), Hospital Regional de Presidente Prudente-Universidade do Oeste Paulista, Presidente Prudente (M.A.C.), and Instituto de Pesquisa Clínica de Campinas, Campinas (J.F.K.S.) - all in Brazil; and Duke Clinical Research Institute, Duke Health, Durham, NC (R.D.L., J.H.A.)
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