Gender Differences in Patient-Reported Outcomes Among Adults With Atherosclerotic Cardiovascular Disease

Background Atherosclerotic cardiovascular disease ( ASCVD ) accounts for approximately one third of deaths in women. Although there is an established relationship between positive patient experiences, health-related quality of life, and improved health outcomes, little is known about gender differences in patient-reported outcomes among ASCVD patients. We therefore compared gender differences in patient-centered outcomes among individuals with ASCVD. Methods and Results Data from the 2006 to 2015 Medical Expenditure Panel Survey, a nationally representative US sample, were used for this study. Adults ≥18 years with a diagnosis of ASCVD , ascertained by International Classification of Diseases, Ninth Revision ( ICD-9) codes and/or self-reported data, were included. Linear and logistic regression were used to compare self-reported patient experience, perception of health, and health-related quality of life by gender. Models adjusted for demographics, socioeconomic status, and comorbidities. There were 21 353 participants included, with \u3e10 000 (47%-weighted) of the participants being women, representing ≈11 million female adults with ASCVD nationwide. Compared with men, women with ASCVD were more likely to experience poor patient-provider communication (odds ratio 1.25 [95% confidence interval 1.11-1.41]), lower healthcare satisfaction (1.12 [1.02-1.24]), poor perception of health status (1.15 [1.04-1.28]), and lower health-related quality of life scores. Women with ASCVD also had lower use of aspirin and statins, and greater odds of ≥2 Emergency Department visits/y. Conclusions Women with ASCVD were more likely to report poorer patient experience, lower health-related quality of life, and poorer perception of their health when compared with men. These findings have important public health implications and require more research towards understanding the gender-specific differences in healthcare quality, delivery, and ultimately health outcomes among individuals with ASCVD

Analysing Life Cycle Stages of Indian Meal Moth, Plodia interpunctella (Hübner) on Four Different Diets

The life cycle stages of Indian meal moth, Plodia interpunctella (H) was studied on four different diets: whole maize flour, whole wheat flour, breadfruit flour and a formulated diet, under ambient laboratory conditions of 28±2oC and 75±5% R.H. The proximate composition of the diets, oviposition, larva instar stages, and the complete developmental duration from egg to adult of the moth were examined on the four different diets. The result showed that the percentage protein value of the formulated diet was significantly higher (14.58) than other diets. The oviposition of the moth on the diets ranges between 1-3 days and about 70% of the eggs laid were on the first day of oviposition in all the diets. The highest number of eggs laid was observed on moths reared on maize flour. Incubation of eggs examined on the diets ranges from 3-4 days. Also, there were variations in the number of larva instar stages in the four diets. The formulated diet recorded the lowest period of pupation (6.33 days) and the total developmental average period (23.50days). The study clearly showed that the formulated diet is suitable for rearing P.  interpunctella under laboratory conditions. Keywords: formulated; incubation; instar; oviposition; pupation

Performance of A Metabolomic Biomarker Score Compared to Three Prognostic Scores in Chronic Heart Failure

The Cardiac Lipid Panel (CLP) is a novel panel of metabolomic biomarkers that has previously shown to improve the diagnostic and prognostic value for CHF patients. Several prognostic scores have been developed for cardiovascular disease (CVD) risk, but their use is limited to specific populations and precision is still inadequate. We compared a risk score using the CLP plus NT-proBNP to three commonly used risk scores: The Seattle Heart Failure Model (SHFM), Framingham Risk Score (FRS), and Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score. We included 280 elderly CHF patients from the Cardiac Insufficiency Bisoprolol Study in Elderly (CIBIS-ELD) trial. Cox Regression and hierarchical cluster analysis was performed. Integrated area under the curves (IAUC) was used as criterium for comparison. The mean (SD) follow-up period was 81 (33) months, and 95 (34%) subjects met the primary endpoint. The IAUC for FRS was 0.53, SHFM 0.61, MAGGIC 0.68, and CLP 0.78. Subjects were partitioned into three risk clusters: low, moderate, high with the CLP score showing the best ability to group patients into their respective risk cluster. A risk score composed of a novel panel of metabolite biomarkers plus NT-proBNP outperformed other common prognostic scores in predicting 10-year cardiovascular death in elderly ambulatory CHF patients. This approach could improve the clinical risk assessment of CHF patients. Keywords: CLP, CHF, chronic, prognosti

National Trends in Nonstatin Use and Expenditures Among the US Adult Population From 2002 to 2013: Insights From Medical Expenditure Panel Survey

BACKGROUND: Evidence supporting nonstatin lipid-lowering therapy in atherosclerotic cardiovascular disease risk reduction is variable. We aim to examine nonstatin utilization and expenditures in the United States between 2002 and 2013. METHODS AND RESULTS: We used the Medical Expenditure Panel Survey database to estimate national trends in nonstatin use and cost (total and out-of-pocket, adjusted to 2013 US dollars using a gross domestic product deflator) among adults 40 years or older. Nonstatin users increased from 3 million (2.5%) in 2002-2003 (20.1 million prescriptions) to 8 million (5.6%) in 2012-2013 (45.8 million prescriptions). Among adults with atherosclerotic cardiovascular disease, nonstatin use increased from 7.5% in 2002-2003 to 13.9% in 2012-2013 after peaking at 20.3% in 2006-2007. In 2012-2013, 15.9% of high-intensity statin users also used nonstatins, versus 9.7% of low/moderate-intensity users and 3.6% of statin nonusers. Nonstatin use was significantly lower among women (odds ratio 0.80; 95% confidence interval 0.75-0.86), racial/ethnic minorities (odds ratio 0.41; 95% confidence interval 0.36-0.47), and the uninsured (odds ratio 0.47; 95% confidence interval 0.40-0.56). Total nonstatin expenditures increased from $1.7 billion (out-of-pocket cost,$0.7 billion) in 2002-2003 to $7.9 billion (out-of-pocket cost$1.6 billion) in 2012-2013, as per-user nonstatin expenditure increased from $550 to$992. Nonstatin expenditure as a proportion of all lipid-lowering therapy expenditure increased 4-fold from 8% to 32%. CONCLUSIONS: Between 2002 and 2013, nonstatin use increased by 124%, resulting in a 364% increase in nonstatin-associated expenditures

Favorable Modifiable Cardiovascular Risk Profile Is Associated With Lower Healthcare Costs Among Cancer Patients: The 2012-2013 Medical Expenditure Panel Survey

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) and cancer are among the leading causes of economic burden, morbidity, and mortality in the United States. We aimed to quantify the overall impact of cardiovascular modifiable risk factor (CRF) profile on healthcare expenditures among those with and without ASCVD and/or cancer. METHODS AND RESULTS: The 2012-2013 Medical Expenditure Panel Survey, a nationally representative adult sample (≥40 years), was utilized for the study. Variables included ASCVD, CRF (hypertension, diabetes mellitus, hypercholesterolemia, smoking, physical activity and/or obesity), and cancer (all). Two-part econometric models analyzed cost data. Medical Expenditure Panel Survey participants (n=27 275, 59±9 years, 52% female) were studied and 14% had cancer, translating to 25.6 million US adults over 40 years of age. A higher prevalence of ASCVD was noted in those with versus without cancer (25% versus 14%). Absence of ASCVD and a more favorable CRF profile were associated with significantly lower expenditures across the spectrum of cancer diagnosis. Among cancer patients, the adjusted mean annual cost for those with and without ASCVD were $10 852 (95$6436 (95% confidence interval [5531, 7342]). Among cancer patients without ASCVD, adjusted annual healthcare expenditures among those with optimal versus poor CRF profile were $4782 and$7256. CONCLUSIONS: In a nationally representative US adult population, absence of ASCVD and a favorable CRF profile were associated with significantly lower medical expenditure among cancer patients. This provides estimates to continue better cardiovascular management and prevention practices, while contextualizing the burden of cancer

Incremental prognostic value of a novel metabolite-based biomarker score in congestive heart failure patients

Aims: The Cardiac Lipid Panel (CLP) is a newly discovered panel of metabolite-based biomarkers that has shown to improve the diagnostic value of N terminal pro B type natriuretic peptide (NT-proBNP). However, little is known about its usefulness in predicting outcomes. In this study, we developed a risk score for 4-year cardiovascular death in elderly chronic heart failure (CHF) patients using the CLP. Methods and results: From the Cardiac Insufficiency Bisoprolol Study in Elderly trial, we included 280 patients with CHF aged \u3e65 years. A targeted metabolomic analysis of the CLP biomarkers was performed on baseline serum samples. Cox regression was used to determine the association of the biomarkers with the outcome after accounting for established risk factors. A risk score ranging from 0 to 4 was calculated by counting the number of biomarkers above the cut-offs, using Youden index. During the mean (standard deviation) follow-up period of 50 (8) months, 35 (18%) subjects met the primary endpoint of cardiovascular death. The area under the receiver operating curve for the model based on clinical variables was 0.84, the second model with NT-proBNP was 0.86, and the final model with the CLP was 0.90. The categorical net reclassification index was 0.25 using three risk categories: 0-60% (low), 60-85% (intermediate), and \u3e85% (high). The continuous net reclassification index was 0.772, and the integrated discrimination index was 0.104. Conclusions: In patients with CHF, incorporating a panel of three metabolite-based biomarkers into a risk score improved the prognostic utility of NT-proBNP by predicting long-term cardiovascular death more precisely. This novel approach holds promise to improve clinical risk assessment in CHF patients. Keywords: Biomarkers; Congestive heart failure; Metabolite profiling; Metabolomics; Prognosi

Response of clarias gariepinus to dietary castor seeds processed by different methods

Castor seed variously treated by boiling, roasting, boiling and roasting, decorticated lyle treated, boiling and fermenting was tested for improved nutrient content and elimination of toxins. 10% processed castor seed cake (CSC) was included in diets and fed to 180 catfishes for 4-weeks to assay the dietary castor seed based on performance and some biochemical indices. Processing methods other than boiling improved performance and other measured parameters and some diets containing treated CSC produced results even better than that obtained on the conventional diet (p < 0.05). Dietary boiled CSC elicited low feed intake, body weight gain, poor feed efficiency and high mortality of the fed fish relative to the control diet (p < 0.05). Similarly, boiled CSC in diet gave poor results on biological values of specific growth rate, net protein utilization, nitrogen metabolism, protein efficiency ratio compared to the control diet or diets containing CSC treated by methods other than boiling (p < 0.05). The best result was obtained on the diet containing castor seeds treated by boiling followed by roasting (p < 0.05). For optimum utilization of CSC in nutrition of fish, it has to be boiled and roasted

Performance of a cardiac lipid panel compared to four prognostic scores in chronic heart failure

The cardiac lipid panel (CLP) is a novel panel of metabolomic biomarkers that has previously shown to improve the diagnostic and prognostic value for CHF patients. Several prognostic scores have been developed for cardiovascular disease risk, but their use is limited to specific populations and precision is still inadequate. We compared a risk score using the CLP plus NT-proBNP to four commonly used risk scores: The Seattle Heart Failure Model (SHFM), Framingham risk score (FRS), Barcelona bio-HF (BCN Bio-HF) and Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score. We included 280 elderly CHF patients from the Cardiac Insufficiency Bisoprolol Study in Elderly trial. Cox Regression and hierarchical cluster analysis was performed. Integrated area under the curves (IAUC) was used as criterium for comparison. The mean (SD) follow-up period was 81 (33) months, and 95 (34%) subjects met the primary endpoint. The IAUC for FRS was 0.53, SHFM 0.61, BCN Bio-HF 0.72, MAGGIC 0.68, and CLP 0.78. Subjects were partitioned into three risk clusters: low, moderate, high with the CLP score showing the best ability to group patients into their respective risk cluster. A risk score composed of a novel panel of metabolite biomarkers plus NT-proBNP outperformed other common prognostic scores in predicting 10-year cardiovascular death in elderly ambulatory CHF patients. This approach could improve the clinical risk assessment of CHF patients

General practitioner reported follow–up visits among asthma patients in North Central Nigeria

Background: Despite the benefits of regular follow–up in the long–term care of asthma, no previous study has reported on it among asthma patients in Nigeria. Objective: This survey was designed to evaluate GP–reported follow–up visits among asthma patients in North Central Nigeria. Methods: It was a cross–sectional survey conducted among GPs in three North Central states of Nigeria. Results: Overall, 48.3% of the GPs reported that their patients usually come for follow-up visits. About 63.6%, 40.0%, and 55.3% of the GPs in Kwara, Kogi, and Niger states, respectively, reported that their patients came for follow–up visits in the month prior to this study. Less than two–third of GPs in both private (55.1%) and public (56.8%) hospitals reportedly attended to patients on follow–up visits. About 46.5%, 37.5%, and 52.0% of the GPs who attended to patients 2 weeks prior to the study reported that their patients came for follow–up visits. There was signifi cant difference (P = 0.04) in the reported follow–up visits by GPs who attended to ≥ 10 asthma patients compared to others. None of the nine GPs who reportedly treated ≥ 10 patients in the preceding month of the study attended to any patient on follow–up visits. Conclusion: The GP–reported rates of follow–up visits in patients that are accessing asthma care from GPs practicing in the North Central part of Nigeria are low. Further studies to identify barriers to follow–up visits and how to correct them are therefore recommended.Keywords: Asthma care, follow—up visits general practitioners, NigeriaArrière-plan: Malgré les avantages de suivi régulier–jusqu’à long - term care de l’asthme, aucune étude antérieure n’a signalé sur elle chez les patients asthmatiques au Nigeria. Objectif: Ce sondage a été conçu pour évaluer les GP–signalés suivi–visites chez les patients asthmatiques au Centre Nord du Nigéria. Méthodes: C’est une croix–sectionnelle enquête menée parmi les GPs dans trois États centrale du Nord du Nigéria. Résultats: Dans l’ensemble, 48,3% des GPs a signalé que les patients sont en général pour des visites de suivi. 63,6% Environ, 40,0% 55,3% des GPs dans les États Kwara, Kogi et au Niger, respectivement, rapporte et que leurs patients sont venus pour suivi–visites dans le mois précédant cette étude. Moins de deux - tiers des GPs dans les hôpitaux publics (56,8%) et le privé (55,1%) auraient été assisté aux patients sur suivi–visites. Environ 46,5%, 37,5% et 52,0% le GPS qui ont participé aux patients 2 semaines avant l’étude rapporte que leurs patients sont venus pour suivi–visites. Il y avait une différence signifi cative (P = 0,04) dans le suivi déclaré–up visites par GPs qui ont participé à ≥ 10 patients asthmatiques par rapport aux autres. Aucun des neuf GPs qui auraient été traités ≥ 10 patients dans le mois précédent de l’étude ont assisté à tout patient sur suivi–visites. Conclusion: Le GP–taux signalés de suivi–visites chez les patients qui sont à accéder aux soins de l’asthme de GPs pratiquant dans la partie centrale du Nord du Nigéria sont faibles. D’autres études pour identifi er les obstacles à suivre–visites et comment à correct eux sont donc recommandés.Mots clés: L’asthme care, suivre — up généralistes, des visites, Nigeri

Association Between Modifiable Risk Factors and Pharmaceutical Expenditures Among Adults With Atherosclerotic Cardiovascular Disease in the United States: 2012-2013 Medical Expenditures Panel Survey

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) causes most deaths in the United States and accounts for the highest healthcare spending. The association between the modifiable risk factors (MRFs) of ASCVD and pharmaceutical expenditures are largely unknown. METHODS AND RESULTS: We examined the association between MRFs and pharmaceutical expenditures among adults with ASCVD using the 2012 and 2013 Medical Expenditure Panel Survey. A 2-part model was used while accounting for the survey\u27s complex design to obtain nationally representative results. All costs were adjusted to 2013 US dollars using the gross domestic product deflator. The annual total pharmaceutical expenditure among those with ASCVD was $71.6 billion, 33$519 [95% confidence interval (CI), $12-918; P=0.011]), dyslipidemia ($631 [95% CI, $168-1094; P=0.008]), hypertension: ($1078 [95% CI, $697-1460; P\u3c0.001)], and diabetes mellitus ($2006 [95% CI, $1470-2542]). Compared with those with optimal MRFs (0-1), those with average MRFs (2-3) spent an average of$1184 (95% CI, $805-1564; P\u3c0.001) more on medications, and those with poor MRFs (≥4) spent$2823 (95% CI, $2338-3307; P\u3c0.001) more. CONCLUSIONS: Worsening MRFs were proportionally associated with higher annual pharmaceutical expenditures among patients with established ASCVD regardless of non-ASCVD comorbidity. In-depth studies of the roles played by other factors in this association can help reduce medication-related expenditures among ASCVD patients