Yu C-M, Lau C-P, Chau J, McGhee S, Kong S-L, Cheung BM-Y, Li LS-W. A short course of cardiac rehabilitation program is highly cost effective in improving long-term quality of life in patients with ...recent myocardial infarction or percutaneous coronary intervention.
To evaluate the long-term effect of a cardiac rehabilitation and prevention program (CRPP) on quality of life (QOL) and its cost effectiveness.
Prospective, randomized controlled trial.
University-affiliated outpatient cardiac rehabilitation and prevention center.
A total of 269 patients (76% men; mean age, 64±11y) with recent acute myocardial infarction (AMI; n=193) or after elective percutaneous coronary intervention (PCI; n=76) were randomized in a ratio of 2 to 1.
Patients received either CRPP (an 8-wk exercise and education class in phase 2) or conventional therapy without exercise program (control group). They were followed until they had completed all 4 phases of the program (ie, 2y).
QOL assessments, by using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and Symptoms Questionnaire, were performed at the end of each phase. Direct health care cost was calculated, whereas cost utility was estimated as money spent (in US$) per quality-adjusted life-year (QALY) gained.
In the CRPP group, 6 of the 8 SF-36 dimensions improved significantly by phase 2 and were maintained throughout the study period. Patients were less anxious and depressed, and felt more relaxed and contented. In the control group, none of the SF-36 dimensions were improved by phase 2, and bodily pain was increased. In phase 4, only 4 dimensions were improved. Symptoms were unchanged except for increased hostility score. There was a significant gain in net time trade-off in the CRPP group after phase 2. The direct health care expenses in the CRPP and control groups were $15,292 and $15,707 per patient, respectively. Therefore, the cost utility calculated was $640 saved per QALY gained. Savings attributable to CRPP were primarily explained by the lower rate (13% vs 26% of patients, χ
2 test=3.9,
P<.05) and cost of subsequent PCI (
P=.01).
In an era of managing patients with coronary heart disease, a short-course CRPP was highly cost effective in providing better QOL to patients with recent AMI or after elective PCI. In addition, the improvement of QOL was quick and sustained for at least 2 years after CRPP.
Background. Clarithromycin is frequently used to treat community-acquired pneumonia in elderly persons. Like erythromycin, it may interact with other drugs by interfering with metabolism by ...cytochrome P450 enzymes and with the P-glycoprotein transporter system. Colchicine, used for treatment of acute gout and for prophylaxis, may cause bone marrow toxicity. It is metabolized by CYP3A4 and is transported by P-glycoprotein. Initial case reports suggested potentially fatal interactions between clarithromycin and colchicine. Methods. A retrospective study was conducted with 116 patients who were prescribed clarithromycin and colchicine during the same clinical admission. Case-control comparisons were made between patients who received concomitant therapy with the 2 drugs and patients who received sequential therapy. We assessed the clinical presentations and outcomes of the 2 patient groups and analyzed the risk factors associated with fatal outcomes. Results. Nine (10.2%) of the 88 patients who received the 2 drugs concomitantly died. Only 1 (3.6%) of the 28 patients who received the drugs sequentially died. Multivariate analysis of the 88 patients who received concomitant therapy showed that longer overlapped therapy (relative risk RR, 2.16; 95% confidence interval CI, 1.41–3.31; P ⩽ .01), the presence of baseline renal impairment (RR, 9.1; 95% CI, 1.75–47.06; P < .001), and the development of pancytopenia (RR, 23.4; 95% CI, 4.48–122.7; P < .001) were independently associated with death. Conclusions. Clarithromycin increases the risk of fatal colchicine toxicity, especially for patients with renal insufficiency. Since there are other drugs for treatment of pneumonia and gout, these 2 drugs should not be coprescribed, because of the risk of fatality.
Atherosclerosis, myocardial infarction, and heart failure are cardiovascular complications in a continuum that begins with risk factors such as hypertension, diabetes, and dyslipidemia. These ...particular cardiovascular risk factors commonly occur together in obese individuals as components of the metabolic syndrome. In Asia, there is a trend toward an increase in the prevalence of the metabolic syndrome and cardiovascular disease. Abdominal adiposity is arguably the key factor underlying the development of insulin resistance and the metabolic syndrome. It is now known that adipose tissues secrete adipokines, and in obese subjects, there is a chronic low-grade inflammation. The inflammation and the associated endothelial dysfunction are reversible in the early stages. The Asian diet is low in animal fat but high in carbohydrates. Recent studies suggest that low-carbohydrate diets are more effective than low fat diets in inducing weight loss, suggesting that excessive carbohydrate rather than fat is the cause of obesity. Strategies to combat cardiovascular disease should now focus on tackling the epidemic of obesity and developing innovative and effective lifestyle and pharmacological interventions.
The α-thalassemias are the most common inherited disorders of hemoglobin synthesis in Southeast Asia and southern China. Their prevalence is 3 to 5 percent in Hong Kong
1
,
2
and 30 to 40 percent in ...northern Thailand and Laos.
3
These disorders arise from deletions or mutations (or both) of α-globin genes, of which there are four in the normal genome. The clinical manifestations of these genetic abnormalities range from the silent carrier state, in which only one α-globin gene is deleted, to fatal hydrops fetalis, in which all four α-globin genes are missing. In hemoglobin H disease, a thalassemia of intermediate . . .
Urotensin II (U-II) is the most potent vasoconstrictor known, even more potent than endothelin-1. It was first isolated from the fish spinal cord and has been recognized as a hormone in the ...neurosecretory system of teleost fish for over 30 years. After the identification of U-II in humans and the orphan human G-protein-coupled receptor 14 as the urotensin II receptor, UT, many studies have shown that U-II may play an important role in cardiovascular regulation. Human urotensin II (hU-II) is an 11 amino acid cyclic peptide, generated by proteolytic cleavage from a precursor prohormone. It is expressed in the central nervous system as well as other tissues, such as kidney, spleen, small intestine, thymus, prostate, pituitary, and adrenal gland and circulates in human plasma. The plasma U-II level is elevated in renal failure, congestive heart failure, diabetes mellitus, systemic hypertension and portal hypertension caused by liver cirrhosis. The effect of U-II on the vascular system is variable, depending on species, vascular bed and calibre of the vessel. The net effect on vascular tone is a balance between endothelium-independent vasoconstriction and endothelium-dependent vasodilatation. U-II is also a neuropeptide and may play a role in tumour development. The development of UT receptor antagonists may provide a useful research tool as well as a novel treatment for cardiorenal diseases.
Researchers are investigating the potential therapeutic use of natriuretic peptides. These are small proteins produced by the heart and brain. Atrial natriuretic peptide (ANP), and brain natriuretic ...peptide (BNP) are the most well-known peptides. Both ANP and BNP increase sodium and water excretion and dilate blood vessels. For this reason, they may be effective antihypertensive agents and might also be used to treat congestive heart failure. Blood levels of ANP and BNP are increased in congestive heart failure and heart attack. Measuring these levels could identify patients with early-stage heart disease.
Exercise and relaxation decrease blood pressure. Qigong is a traditional Chinese exercise consisting of breathing and gentle movements. We conducted a randomised controlled trial to study the effect ...of Guolin qigong on blood pressure. In all, 88 patients with mild essential hypertension were recruited from the community and randomised to Goulin qigong or conventional exercise for 16 weeks. The main outcome measurements were blood pressure, health status (SF-36 scores), Beck Anxiety and Depression Inventory scores. In the qigong group, blood pressure decreased significantly from 146.3+/-7.8/93.0+/-4.1 mmHg at baseline to 135.5+/-10.0/87.1+/-7.7 mmHg at week 16. In the exercise group, blood pressure also decreased significantly from 140.9+/-10.9/93.1+/-3.5 mmHg to 129.7+/-11.1/86.0+/-7.0 mmHg. Heart rate, weight, BMI, waist circumference, total cholesterol, renin and 24 h urinary albumin excretion significantly decreased in both groups after 16 weeks. General health, bodily pain, social functioning and depression also improved in both groups. No significant differences between qigong and conventional exercise were found. In conclusion, Guolin qigong and conventional exercise have similar effects on blood pressure in patients with mild hypertension. While no additional benefits were identified, it is nevertheless an alternative to conventional exercise in the nondrug treatment of hypertension.
Obesity is known to be a major aetiological factor in the development of hypertension. It also leads to dyslipidaemia and raised blood glucose. All of these are components of the metabolic syndrome. ...Thus, hypertension, as part of the syndrome, is often found together with these other abnormalities. Obesity raises blood pressure by a number of mechanisms, including activation of the sympathetic nervous system and the renin- angiotensin system. Apart from cardiovascular disease and diabetes, the metabolic syndrome is also associated with fatty liver disease, sleep apnoea and some malignancies. Measures to reduce obesity through lifestyle changes are therefore highly desirable, not because of reductions in blood pressure alone.
Inappropriate abbreviations used in prescriptions have led to medication errors. We investigated the use of error-prone and other unapproved abbreviations in prescriptions, and assessed the attitudes ...of pharmacists on this issue.
A reference list of error-prone abbreviations was developed. Prescriptions of outpatients and specialty clinic patients in a teaching hospital in Sri Lanka were reviewed during one month. An interviewer administered questionnaire was used to assess attitudes of pharmacists.
3370 drug items (989 prescriptions) were reviewed. The mean (standard deviation) number of abbreviations per prescription was 5.9 (3.5). The error-prone abbreviations used in the hospital were, μg (microgram), mcg (microgram), u (units), cc (cubic centimeter), OD (once a day), @ sign, d (days/daily), m (morning) and n (night), and among all prescriptions reviewed, they were used at a rate of 17.4%, 0.1%, 1.9%, 0.2%, 0.2%, 4.9%, 23.5%, 4.4% and 15.8% respectively. Among the 103 types of abbreviations observed, 71 were not standard acceptable abbreviations. Multiple abbreviations were used to indicate a single drug item/ instruction (N = 7). The abbreviation 'd' was used to denote 'daily' as well as 'days'. All pharmacists believed that using error-prone abbreviations will always (5.3%) or sometimes (94.7%) lead to medication errors.
Error-prone abbreviations and many other unapproved abbreviations are frequently used in hospitals. There is a need to educating health care professionals on this issue and introduce an in-house error-prone abbreviation list for their guidance.
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