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Introduction:Following the inception of the COVID-19 pandemic, chloroquine compounds were proposed as potential therapeutic strategies, at the cost of a potential increase in cardiovascular risk. We aimed to evaluate clinical outcomes of patients with COVID-19, comparing those using chloroquine compounds to individuals without specific treatment.Methods:Outpatients with suspected COVID-19 in Brazil who had at least 1 ECG transmitted to a Telehealth Network, were prospectively enrolled in 2 arms (G1: treatment with chloroquine compounds and G2: without specific treatment) and G3: registry of other specific treatments. Outcomes were assessed through follow-up phone calls on days 3 and 14, and also administratively collected from national mortality and hospitalization databases. The primary outcome was composed of: hospitalization and all-cause death. The association between treatment groups and the primary outcome was evaluated by logistic regression. Significant variables (p<0.10) were included in 4 multivariate models: 1: unadjusted; 2: adjusted for age and sex; 3: adjusted for model 2 plus cardiovascular risk factors and 4: adjusted for model 3 plus COVID-19 symptoms (when available from phone contact).Results:In 303 days, 712 (10.2%) patients were allocated in G1 (chloroquine), 3623 (52.1%) in G2 (control) and 2622 (37.7%) in G3 (other treatments). Median age was 49 (IQR 38 - 62) years, 57% women. Of these, 1969 had successful phone contacts (G1: 260; G2: 871; G3: 838). The primary outcome was more frequent in groups 1 and 3 compared to the control group, when assessed exclusively by phone (G1: 38,5% vs. G2: 18,0% vs. G3: 34,2%, p<0,001) or combined with administrative data (G1: 19,5% vs. G2: 11,0% vs. G3: 18,2%, p<0,001). In the adjusted models, chloroquine independently associated with a greater chance of the primary outcome: phone contact (model 4): OR=3.24 (95% CI 2.31 - 4.54), p<0.001; phone + administrative data (model 3): OR=1.99 (95% CI 1.61 - 2.44), p<0.001. Chloroquine also independently associated with higher mortality, as assessed by phone + administrative data (model 3): OR=1.67 (95% CI 1.20 - 2.28).Conclusion:Chloroquine compounds associated with a higher risk of poor outcomes in outpatients with COVID-19 compared to standard care.

Introduction:The impact of cardiovascular diseases (CVD) is more pronounced in low-income and resource constrained regions, where recognition and control of risk factors are more deficient. Hypertension and diabetes mellitus (DM) are important modifiable risk factors for CVD, but the rates of control of these diseases are still low.Objective:To assess the impact of the implementation of a multifaceted intervention in primary care, on the control of hypertension and DM in patients of a low-income and resource constrained Brazilian region.Methods:The HealthRise Brazil Te?filo Otoni Project was a quasi-experimental study, part of a multinational study, conducted in partnership with the Medtronic Foundation, Abt Associates and the Institute for Health Metrics and Evaluation. The intervention included training of primary care practitioners, strengthening of educational groups, development and implementation of a clinical decision support system and increasing the access to exams. It was implemented in 34 primary care centers of 10 municipalities in the Te?filo Otoni micro-region, Minas Gerais, a low-income and resource constrained region. The patients were followed from October/17 to October/18.Results:In total, 1028 patients with DM (71% women, median age 56 [interquartile range - IQ 49-62] years) and 3992 patients with hypertension (67% women, median age 55 [IQ 48-62] years) were included. There was an average absolute reduction of 0.7% (95% confidence interval [CI] 0.4-0.9; p<0.01), and significantly more patients met treatment targets (HbA1c<7%) at endline when compared to baseline (60.7 vs. 52.1%; p<0.05). Among patients with hypertension, there was a statistically significant reduction in systolic blood pressure (SBP), with an average decrease of 1.9 mmHg (95% CI 0.7-3.1; p<0.01), and a significantly higher number of patients meeting hypertension treatment targets (SBP <140mmHg and diastolic BP <90 mmHg) at endline when compared to baseline (52.2% vs. 48.3%; p<0.05).Conclusions:The implementation of a multifaceted intervention in primary care in this low-income and resource constrained region was associated with a reduction in HbA1c and SBP and improvement of control levels in patients with DM and hypertension.