AbstractIntroductionUnderstanding potential harms associated with common anticoagulation treatment patterns in patients with venous thromboembolism (VTE) is important for multiple stakeholders. The ...purpose of this study is to report associations between different anticoagulation patterns and bleeding and emotional harms based on patients' self-reported care experiences. MethodsPatients at least 18 years of age who had experienced a VTE event in the past two years and completed a national online survey between May and July 2016 were analyzed. The survey assessed the prevalence of self-reported bleeding and emotional harms associated with self-reported anticoagulation treatment patterns and other variables. ResultsPatients mean age was 52.4 (standard deviation 14.4) years and most were female (56.7%) and Caucasian (88.6%). Anticoagulant treatment patterns included warfarin (38.7%), direct oral anticoagulants (26.1%), and those who switched between anticoagulants (17.9%). Self-reported bleeding and emotional harms occurred in 63.6% and 56.3% of patients, respectively. Younger age, experiencing VTE more recently, and a prior history of anxiety, depression, or stroke were associated with increased odds of experiencing bleeding or emotional harm. Compared to warfarin, switching between anticoagulant types was associated with approximately twice the odds of experiencing bleeding harm, while DOAC therapy was associated with lower odds of experiencing emotional harm. ConclusionSelf-reported bleeding and emotional harms occurred commonly during VTE treatment and were associated with identifiable clinical, demographic, and psychosocial characteristics such as younger age, history of depression and/or anxiety, and more recent VTE diagnosis. Switching between anticoagulants may be a marker for increased harm risk.
There has been a 10‐year hiatus in the approval of a new pharmacotherapy for patients with chronic heart failure with a reduced ejection fraction (HFrEF). Combining an angiotensin receptor blocker, ...valsartan, with sacubitril, an inhibitor of neprilysin, results in increasing levels of natriuretic peptides that counterbalance high circulating levels of neurohormones in HFrEF. This has resulted in the development of a new agent, LCZ696. A comprehensive overview of LCZ696, its pharmacology, its role in the pathophysiology of HFrEF, completed and future clinical trial information, specific critical issues, and the place of LCZ696 in HFrEF therapy are presented.
To quantify and model drivers of community pharmacists' self-reported levels of occupational satisfaction and stress and to identify key segments for possible intervention by the profession.
...Descriptive nonexperimental study.
United States during January to February 2012.
303 independent and community chain pharmacists.
Online survey instrument of previously validated occupational stress and satisfaction attribute batteries.
Participants reported a high level of dissatisfaction with current employment, with more than 50% stating that they were considering quitting their jobs. Dissatisfaction was higher among those with a doctor of pharmacy degree and those employed in community chains. Occupational stress and satisfaction were highly correlated with the intention to search for a new position. Approximately 20% of respondents felt that stress from their employment adversely affected their mental health and well-being, physical health, quality of the work, or relationships with family and friends.
Substantive levels of occupational dissatisfaction and stress exist among pharmacists currently in community practice. These negative attributes are associated with a damaging promotion of community practice-a marker of a negative trajectory in sustaining this practice environment. The results of this study have implications for the health care industry, commercial pharmacy vendors, independent pharmacies, the profession, and academic training institutions as they prepare the pharmacy workforce of the future for potentially dissatisfying and stressful work environments.
Background Atrial fibrillation (AF) is a comorbidity associated with heart failure and catecholaminergic polymorphic ventricular tachycardia. Despite the Ca
-dependent nature of both of these ...pathologies, AF often responds to Na
channel blockers. We investigated how targeting interdependent Na
/Ca
dysregulation might prevent focal activity and control AF. Methods and Results We studied AF in 2 models of Ca
-dependent disorders, a murine model of catecholaminergic polymorphic ventricular tachycardia and a canine model of chronic tachypacing-induced heart failure. Imaging studies revealed close association of neuronal-type Na
channels (nNa
) with ryanodine receptors and Na
/Ca
exchanger. Catecholamine stimulation induced cellular and in vivo atrial arrhythmias in wild-type mice only during pharmacological augmentation of nNa
activity. In contrast, catecholamine stimulation alone was sufficient to elicit atrial arrhythmias in catecholaminergic polymorphic ventricular tachycardia mice and failing canine atria. Importantly, these were abolished by acute nNa
inhibition (tetrodotoxin or riluzole) implicating Na
/Ca
dysregulation in AF. These findings were then tested in 2 nonrandomized retrospective cohorts: an amyotrophic lateral sclerosis clinic and an academic medical center. Riluzole-treated patients adjusted for baseline characteristics evidenced significantly lower incidence of arrhythmias including new-onset AF, supporting the preclinical results. Conclusions These data suggest that nNa
s mediate Na
-Ca
crosstalk within nanodomains containing Ca
release machinery and, thereby, contribute to AF triggers. Disruption of this mechanism by nNa
inhibition can effectively prevent AF arising from diverse causes.
Study Objective
To determine the effect of dobutamine versus milrinone on out‐of‐hospital mortality in the treatment of patients with acute decompensated heart failure (ADHF).
Design
Propensity score ...weighted retrospective cohort study with mortality as the primary outcome.
Setting
An academic health care system.
Patients
Five hundred adult patients with a prior history of heart failure who survived a hospitalization for ADHF that included treatment with dobutamine or milrinone between January 1, 2006, and April 30, 2014.
Measurements and Main Results
ADHF events were defined as a hospitalization with receipt of an intravenous loop diuretic or a brain‐type natriuretic peptide (BNP) value greater than 400 pg/ml during the hospitalization. Patients were followed until death or 180 days from hospital discharge. Risk ratios (RRs) for mortality associated with dobutamine compared with milrinone were calculated at 15, 30, and 180 days postdischarge using Poisson regression with robust error variance. Mean age was 62.7 years, 65.4% were male, and 48.2% had a mean left ventricular ejection fraction (LVEF) of 40% or lower. Overall, 55 (18%) of dobutamine‐treated versus 23 (12%) of milrinone‐treated patients died during follow‐up (RR 1.27, 95% confidence interval CI 0.76–2.13, p=0.360). For death from cardiovascular causes, the RR for dobutamine was 1.49 (95% CI 0.79–2.82, p=0.214). For death from worsening heart failure, the RR for dobutamine was 2.55 (95% CI 1.07–6.10, p=0.035). A trend toward significance was observed at day 15 after discharge for all mortality analyses (all p values < 0.10).
Conclusions
Dobutamine was associated with higher short‐term out‐of‐hospital mortality compared with milrinone in patients with ADHF. These results replicate and extend prior associations with mortality and should be confirmed in a prospective study.
Venous thromboembolism (VTE) represents a major health-care problem. Understanding patient satisfaction with VTE care is an important health-care goal. A national online survey was administered to ...adults who had experienced a recent VTE event. The survey assessed patient satisfaction by: (1) satisfaction with VTE care provider; (2) likelihood to recommend VTE provider; and (3) satisfaction with communication between VTE care providers. Each question was correlated with patient demographics, patient care harms (ie, misdiagnosis, wrong treatment), patient beliefs concerning outcomes, and type of anticoagulant therapy. Respondents (907) were 52.4 ± 14.4 years, predominantly Caucasian, mostly women, and generally had health insurance. Most respondents were satisfied with VTE care providers, likely to recommend their VTE provider, and satisfied with communication between providers. Dissatisfaction was strongly associated with treatment mistakes, a wrong diagnosis or treatment, or delayed treatment. A national sample of VTE patients were generally satisfied with VTE care experiences. The VTE care dissatisfaction was strongly associated with perceived mistakes in VTE care. Interventions aimed at reducing, acknowledging, and communicating errors could be studied to improve VTE care satisfaction.
Abstract only
Introduction:
Pregabalin, a structural analog to λ-aminobutyric acid, is prescribed for neurological disorders. Through actions to cause sodium/water retention, the agent may increase ...the risk of acute heart failure (AHF).
Methods:
We performed a retrospective cohort study using a repository of healthcare records obtained from a large U.S. academic healthcare system. HF patients were identified between 1/1/2016-12/31/2020. Patients who had initiated treatment with pregabalin were compared to patients with no post-HF pregabalin over a 365-day post-pregabalin period or post-HF period. Study outcomes were per-patient per-year (PPPY) emergency department (ED) admissions or PPPY hospitalizations, time-to first ED admission, and time-to hospitalizations. Outcomes encounters were adjudicated by a HF diagnosis (ICD-10, I50.x) at any position. We tested the association between the pregabalin exposure and outcomes using generalized linear regression and Cox-proportional hazard regression approach.
Results:
The study cohort included 483 pregabalin-HF patients and 21,150 pregabalin-naïve HF patients. The pregabalin-HF patients age was (mean±SEM: 62.2±0.7 vs. 66.2±0.1 years,
p
<0.0001) and more females (54.9% vs, 44.4%,
p
<0.0001) than pregabalin-naïve HF patients. Charleston comorbidity score was 3.66±0.14 vs. 3.23±0.02 (
p
=0.007). Pregabalin use was associated with a 13% increase in PPPY AHF hospitalizations (
p
<0.036). A 15% increase in the PPPY ED pregabalin admissions was noted (
p
=0.1142). Pregabalin ED admission or AHF hospitalization were 1.492 (95% CI: 1.204 ̶ 1.850
p
=0.0003) and 1.112 (95% CI: 0.922 ̶ 1.340
p
=0.2663).
Conclusion:
This retrospective cohort study shows pregabalin is associated with an increased risk of AHF in patients with existing HF. Pregabalin prescribing in HF should be considered with caution. Further signal evaluation to test the robust association between pregabalin and AHF is warranted.
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