5 research outputs found
Health-related quality of life after myocardial infarction is associated with level of left ventricular ejection fraction
<p>Abstract</p> <p>Background</p> <p>The objective was to explore the relationship between left ventricular ejection fraction (LVEF) assessed during hospitalization for acute myocardial infarction (MI) and later health-related quality of life (HRQoL).</p> <p>Methods</p> <p>We used multivariable linear regression to assess the relationship between LVEF and HRQoL in 256 MI patients who responded to the Kansas City Cardiomyopathy Questionnaire (KCCQ), the EQ-5D Index, and the EuroQol Visual Analogue Scale (EQ-VAS) 2.5 years after the index MI.</p> <p>Results</p> <p>167 patients had normal LVEF (>50%), 56 intermediate (40%–50%), and 33 reduced (<40%). The mean (SD) KCCQ clinical summary scores were 85 (18), 75 (22), and 68 (21) (<it>p </it><0.001) in the three groups, respectively. The corresponding EQ-5D Index scores were 0.83 (0.18), 0.72 (0.27), and 0.76 (0.14) (<it>p </it>= 0.005) and EQ-VAS scores were 72 (18), 65 (21), and 57 (20) (<it>p </it>= 0.001). In multivariable linear regression analysis age ≥ 70 years, known chronic obstructive pulmonary disease (COPD), subsequent MI, intermediate LVEF, and reduced LVEF were independent determinants for reduced KCCQ clinical summary score. Female sex, medication for angina pectoris at discharge, and intermediate LVEF were independent determinants for reduced EQ-5D Index score. Age ≥ 70 years, COPD, and reduced LVEF were associated with reduced EQ-VAS score.</p> <p>Conclusion</p> <p>LVEF measured during hospitalization for MI was a determinant for HRQoL 2.5 years later.</p
Drugs with narrow therapeutic index as indicators in the risk management of hospitalised patients
Drugs with narrow therapeutic index (NTI-drugs) are
drugs with small differences between therapeutic
and toxic doses. The pattern of drug-related
problems (DRPs) associated with these drugs has
not been explored.
Objective: To investigate how, and to what extent
drugs, with a narrow therapeutic index (NTI-drugs),
as compared with other drugs, relate to different
types of drug-related problems (DRPs) in
hospitalised patients.
Methods: Patients from internal medicine and
rheumatology departments in five Norwegian
hospitals were prospectively included in 2002.
Clinical pharmacists recorded demographic data,
drugs used, medical history and laboratory data.
Patients who used NTI-drugs (aminoglycosides,
ciclosporin, carbamazepine, digoxin, digitoxin,
flecainide, lithium, phenytoin, phenobarbital,
rifampicin, theophylline, warfarin) were compared
with patients not using NTI-drugs. Occurrences of
eight different types of DRPs were registered after
reviews of medical records and assessment by
multidisciplinary hospital teams. The drug risk ratio,
defined as number of DRPs divided by number of
times the drug was used, was calculated for the
various drugs.
Results: Of the 827 patients included, 292 patients
(35%) used NTI-drugs. The NTI-drugs were
significantly more often associated with DRPs than
the non-NTI-drugs, 40% versus 19% of the times
they were used. The drug risk ratio was 0.50 for
NTI-drugs and 0.20 for non-NTI-drugs. Three
categories of DRPs were significantly more
frequently found for NTI-drugs: non-optimal dose,
drug interaction, and need for monitoring.
Conclusion: DRPs were more frequently associated
with NTI-drugs than with non-NTI-drugs, but the
excess occurrence was solely related to three of the
eight DRP categories recorded. The drug risk ratio is a well-suited tool for characterising the risk
attributed to various drugs.Los medicamentos con estrecho margen terapéutico
(NTI) son medicamentos con pequeñas diferencias
entre las dosis terapéuticas y tóxicas. No se han
explorado los problemas relacionados con
medicamentos (DRPs) de estos medicamentos.
Objetivo: Investigar cómo y cuanto se relacionan
los tipos de problemas relacionados con
medicamentos de estrecho margen terapéutico con
los de otros medicamentos en pacientes
hospitalizados.
Métodos: Se incluyeron prospectivamente en 2002
los pacientes de medicina interna y reumatologÃa de
5 hospitales noruegos. Farmacéuticos clÃnicos
registraron los datos demográficos, medicamentos
utilizados, historial médico y datos de laboratorio.
Los pacientes que usaban NTI (aminoglucósidos,
ciclosporina, carbamazepina, digoxina, digitoxina,
flecainamida, litio, fenitoina, fenobarbital,
rifampicina, teofilina, warfarina) se compararon
con pacientes que no usaban NTI. Se registraron las
apariciones de los 8 tipos de DRPs después de
revisiones de los registros médicos y evaluación del
equipo multidisciplinario del hospital. Se calculó
para los varios medicamentos el ratio de riesgo de
medicamento, definido como el número de DRP
dividido por el número de veces que se uso el
medicamento.
Resultados: De los 827 pacientes incluidos, 292
(35%) utilizaron NTI. Los NTI estaban
significativamente más asociados a DRP que los no
NTI, 40% contra 19% de las veces que se
utilizaron. El ratio de riesgo de medicamento fue de
0,50 para los NTI y de 0,20 para los no-NTI. Tres
categorÃas de DRP que se encontraron más
significativamente en los NTI: dosis no-óptima,
interacción medicamentosa, y necesidad de
monitorización.
Conclusión: Los DRP estaban más frecuentemente
asociados a medicamentos NTI que a los no-NTI,
pero el exceso de aparición de DRP estaba
relacionado solamenrte con tres de las ocho categorÃas de DRP. El ratio de riesgo de
medicamento es una herramienta apropiada para
caracterizar el riesgo atribuido a diversos
medicamentos