Clinical outcomes and healthcare expenditures in the real world with left ventricular assist devices - The CLEAR-LVAD study

BACKGROUND: Several distinctly engineered left ventricular assist devices (LVADs) are in clinical use. However, contemporaneous real world comparisons have not been conducted, and clinical trials were not powered to evaluate differential survival outcomes across devices. OBJECTIVES: Determine real world survival outcomes and healthcare expenditures for commercially available durable LVADs. METHODS: Using a retrospective observational cohort design, Medicare claims files were linked to manufacturer device registration data to identify de-novo, durable LVAD implants performed between January 2014 and December 2018, with follow-up through December 2019. Survival outcomes were compared using a Cox proportional hazards model stratified by LVAD type and validated using propensity score matching. Healthcare resource utilization was analyzed across device types by using nonparametric bootstrap analysis methodology. Primary outcome was survival at 1-year and total Part A Medicare payments. RESULTS: A total of 4,195 de-novo LVAD implants were identified in fee-for-service Medicare beneficiaries (821 HeartMate 3; 1,840 HeartMate II; and 1,534 Other-VADs). The adjusted hazard ratio for mortality at 1-year (confirmed in a propensity score matched analysis) for the HeartMate 3 vs HeartMate II was 0.64 (95% CI; 0.52-0.79, p\u3c 0.001) and for the HeartMate 3 vs Other-VADs was 0.51 (95% CI; 0.42-0.63, p \u3c 0.001). The HeartMate 3 cohort experienced fewer hospitalizations per patient-year vs Other-VADs (respectively, 2.8 vs 3.2 EPPY hospitalizations, p \u3c 0.01) and 6.1 fewer hospital days on average (respectively, 25.2 vs 31.3 days, p \u3c 0.01). The difference in Medicare expenditures, conditional on survival, for HeartMate 3 vs HeartMate II was -$10,722, p \u3c 0.001 (17.4$17,947, p \u3c 0.001 (26.1% reduction). CONCLUSIONS: In this analysis of a large, real world, United States. administrative dataset of durable LVADs, we observed that the HeartMate 3 had superior survival, reduced healthcare resource use, and lower healthcare expenditure compared to other contemporary commercially available LVADs

Vaccinations, cardiovascular drugs, hospitalisation and mortality in COVID-19 and Long COVID.

OBJECTIVE: To identify highest-risk subgroups for COVID-19 and Long COVID(LC), particularly in contexts of influenza and cardiovascular disease(CVD). METHODS: Using national, linked electronic health records for England(NHS England Secure Data Environment via CVD-COVID-UK/COVID-IMPACT Consortium), we studied individuals(of all ages) with COVID-19 and LC (2020-2023). We compared all-cause hospitalisation and mortality by prior CVD, high CV risk, vaccination status(COVID-19/influenza), and CVD drugs, investigating impact of vaccination and CVD prevention using population preventable fractions. RESULTS: Hospitalisation and mortality were 15.3% and 2.0% among 17,373,850 individuals with COVID-19(LC rate 1.3%), and 16.8% and 1.4% among 301,115 with LC. Adjusted risk of mortality and hospitalisation were reduced with COVID-19 vaccination≥2 doses(COVID-19:HR 0.36 and 0.69; LC:0.44 and 0.90). With influenza vaccination, mortality was reduced, but not hospitalisation(COVID-19:0.86 and 1.01, and LC:0.72 and 1.05). Mortality and hospitalisation were reduced by CVD prevention in those with CVD, e.g. anticoagulants- COVID:19:0.69 and 0.92; LC:0.59 and 0.88; lipid lowering- COVID-19:0.69 and 0.86; LC:0.68 and 0.90. COVID-19 vaccination averted 245044 of 321383 and 7586 of 8738 preventable deaths after COVID-19 and LC, respectively. INTERPRETATION: Prior CVD and high CV risk are associated with increased hospitalisation and mortality in COVID-19 and LC. Targeted COVID-19 vaccination and CVD prevention are priority interventions. FUNDING: NIHR. HDR UK

Health literacy, dementia knowledge and perceived utility of digital health modalities among future health professionals

Objectives: Studies of dementia knowledge (including dementia risk reduction) in health-care trainees highlight varying levels of understanding across countries and disciplines. This draws attention to the need for a well-trained health workforce with the knowledge to champion and implement such strategies. This study (a) assessed dementia knowledge and health literacy among a sample of Australian health-care students, (b) identified modality preferences of digital health interventions addressing dementia prevention and (c) examined potential relationships among health literacy, dementia knowledge, dementia prevention knowledge and a student's preferences for different digital health modalities. Methods: A cross-sectional survey assessed dementia knowledge and health literacy in 727 health students across 16 Australian universities representing both metropolitan and regional cohorts. The All Aspects of Health Literacy Scale and the Dementia Knowledge Assessment Scale were administered. Questions about the perceived effectiveness of strategies and preferred digital health modalities for dementia prevention/risk reduction were asked. Results: The students had relatively high health literacy scores. However, dementia knowledge and evidence-based dementia prevention knowledge were average. Only 7% claimed knowledge of available dementia-related digital health interventions. Associations among health literacy, dementia knowledge and dementia prevention, with recommendations for different digital modalities, are presented. Conclusions: Health-related degrees need to increase dementia knowledge, health literacy and knowledge of effective dementia-related digital health interventions. It is imperative to equip the future health workforce amid an ageing population with increased dementia rates and where evidence-based digital health interventions will increasingly be a source of support

Exploring the experiences and coping strategies of international medical students

<p>Abstract</p> <p>Background</p> <p>Few studies have addressed the challenges that international medical students face and there is a dearth of information on the behavioural strategies these students adopt to successfully progress through their academic program in the face of substantial difficulties of language barrier, curriculum overload, financial constraints and assessment tasks that require high proficiency in communication skills.</p> <p>Methods</p> <p>This study was designed primarily with the aim of enhancing understanding of the coping strategies, skill perceptions and knowledge of assessment expectations of international students as they progress through the third and fourth years of their medical degree at the School of Medicine, University of Tasmania, Australia.</p> <p>Results</p> <p>Survey, focus group discussion and individual interviews revealed that language barriers, communication skills, cultural differences, financial burdens, heavy workloads and discriminatory bottlenecks were key factors that hindered their adaptation to the Australian culture. Quantitative analyses of their examination results showed that there were highly significant (p < 0.001) variations between student performances in multiple choice questions, short answer questions and objective structured clinical examinations (70.3%, 49.7% & 61.7% respectively), indicating existence of communication issues.</p> <p>Conclusions</p> <p>Despite the challenges, these students have adopted commendable coping strategies and progressed through the course largely due to their high sense of responsibility towards their family, their focus on the goal of graduating as medical doctors and their support networks. It was concluded that faculty needs to provide both academic and moral support to their international medical students at three major intervention points, namely point of entry, mid way through the course and at the end of the course to enhance their coping skills and academic progression. Finally, appropriate recommendations were made.</p

Psychological and Environmental Correlates of Well-being Among Undergraduate University Students

This study explored whether the university environment provides similar well-being enhancing elements to those that have been found in the workplace and school contexts. Whether psychological inflexibility accounts for well-being over and above personality and environmental influences was also explored. A representative sample of 163 undergraduate university students in an Australian university completed an online survey measuring the key constructs. Environmental influences assessed included financial resources, physical security, opportunity to use new skills, externally generated goals, variety, environmental clarity, interpersonal contact, and valued social position. Hierarchical multiple linear regression analyses were then conducted to test for predictors of three domains of subjective well-being: positive affect, negative affect, and life satisfaction. The results suggested that university context contributes significantly to undergraduate students’ well-being by providing a valued social role, externally generated goals, and variety. Students’ perception of their physical security was also an important influence on their well-being. These results are consistent with the literature on well-being and employment. Neuroticism significantly predicted negative affect, while psychological inflexibility accounted for unique variance in life satisfaction and negative affect even when personality and environmental influences were taken into account. The implications of these findings for enhancing undergraduate university students’ well-being are discussed

Digital health literacy to enhance workforce skills and clinical effectiveness: A response to 'Digital health literacy: Helpful today, dependency tomorrow? Contingency planning in a digital age'

We respond to Pietris et al.'s letter to the editor,1 which focusses on the role of artificial intelligence (AI). Health literacy, dementia knowledge and perceived utility of digital health modalities among future health professionals.2 We thank them for their interest in our work and embarking on a productive debate. In reply, we provide a balanced perspective congruent with current health evidence. We agree that educating the future health workforce to critically appraise the use of technology, including AI, is important. Health students' curriculum includes understanding evidence-based practice and critically appraising scientific papers. Now, critical appraisal of technology (including AI) is prudent