Rationale Adaptive servo ventilation (ASV) is contraindicated in patients with systolic heart failure (HF) who have a left ventricular ejection fraction (LVEF) below 45% and predominant central sleep ...apnoea (CSA). However, the effects of ASV in other HF subgroups have not been clearly defined. Objective The European, multicentre, prospective, observational cohort trial, FACE, evaluated the effects of ASV therapy on morbidity and mortality in patients with HF with sleep-disordered breathing (SDB); 3-month outcomes in patient subgroups defined using latent class analysis (LCA) are presented. Methods Consecutive patients with HF with predominant CSA (±obstructive sleep apnoea) indicated for ASV were included from 2009 to 2018; the non-ASV group included patients who refused/were noncompliant with ASV. The primary endpoint was time to composite first event (all-cause death, lifesaving cardiovascular intervention or unplanned hospitalisation for worsening of chronic HF). Measurements and main results Baseline assessments were performed in 503 patients, and 482 underwent 3-month follow-up. LCA identified six discrete patient clusters characterised by variations in LVEF, SDB type, age, comorbidities and ASV acceptance. The 3- month rate of primary outcome events was significantly higher in cluster 1 patients (predominantly men, low LVEF, severe HF, CSA; 13.9% vs 1.5%–5% in other clusters, p<0.01). Conclusion For the first time, our data identified homogeneous patient clusters representing clinically relevant subgroups relating to SDB management in patients with HF with different ASV usage, each with a different prognosis. This may improve patient phenotyping in clinical practice and allow individualisation of therapy.
To this end, in a major move to increase access to cancer medicines in low-income and middle-income countries (LMICs), WHO has added ten new cancer therapies to its 21st Model List of Essential ...Medicines.1 When WHO labels medicines as essential, it means that they have proven their utility and should be available and affordable to all. ...these medicines should be included in national essential medicines lists, which would enable governments to use scarce resources to select medicines more effectively. Lenalidomide is an essential medicine for the treatment of multiple myeloma. ...2016, South African patients had access to generic lenalidomide manufactured in India under a section 21 legal authorisation that allows the sale and use of unregistered products. A third of the cancer medicines studied had already reached blockbuster status with over $1 billion annual sales income.7 Most of these sales take place in HICs. ...making these new medicines affordable in LMICs is not likely to impair future research and development.
World Bank's world development report de Wildt, Gilles; Sogge, David; Peters, Arnold ...
The Lancet (British edition),
08/1993, Letnik:
342, Številka:
8868
Journal Article
Recenzirano
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SBJE, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
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