Active over 45 : a step-up jogging programme for inactive female hospital staff members aged 45+

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch) © The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.Background: Inactive individuals face motivational obstacles for becoming and remaining physically active. Therefore, sustainable physical activity promotion programmes tailored to reach inactive individuals are needed. The aim of this study was to test the role of motivation and the effect and feasibility of a training programme. Methods: We enrolled physically inactive female hospital staff members aged 45 and older in an uncontrolled exercise trial. Follow-up assessments were at 3 and 12 months. The primary outcome was running distance (Cooper test). Secondary outcomes were level of physical activity (Freiburger Physical Activity Questionnaire) and body mass index. Results: Out of 1249 female hospital staff, 275 classified themselves as inactive and 250 (91%) of them were interested in the exercise programme. Of these, 68 (27%; mean age 53.2 years) agreed to participate in our study and 47 (69%) completed the programme. Average running distance increased by 255.70 m [95% confidence interval (CI) 208.09-303.31] at 3-month follow-up with a sustained benefit at 12-month follow-up (194.02; 95% CI 143.75-244.47). Physical activity level increased by 1152.52 kcal week-1 (95% CI 703.73-1601.32) at 3 months with a sustained benefit (1279.10 kcal week−1, 95% CI 826.80–1731.40) after 12 months. Notably, baseline motivation to become physically active was not associated with change in physical performance or physical activity level during the programme. Conclusion: The 3-month step-up jogging programme is a feasible and effective exercise intervention for physically inactive, middle-aged female hospital staff members. The intervention leads to sustained benefits independently of motivation to become more physically active

Active over 45: a step-up jogging programme for inactive female hospital staff members aged 45+

Background: Inactive individuals face motivational obstacles for becoming and remaining physically active. Therefore, sustainable physical activity promotion programmes tailored to reach inactive individuals are needed. The aim of this study was to test the role of motivation and the effect and feasibility of a training programme. Methods: We enrolled physically inactive female hospital staff members aged 45 and older in an uncontrolled exercise trial. Follow-up assessments were at 3 and 12 months. The primary outcome was running distance (Cooper test). Secondary outcomes were level of physical activity (Freiburger Physical Activity Questionnaire) and body mass index. Results: Out of 1249 female hospital staff, 275 classified themselves as inactive and 250 (91%) of them were interested in the exercise programme. Of these, 68 (27%; mean age 53.2 years) agreed to participate in our study and 47 (69%) completed the programme. Average running distance increased by 255.70 m [95% confidence interval (CI) 208.09-303.31] at 3-month follow-up with a sustained benefit at 12-month follow-up (194.02; 95% CI 143.75-244.47). Physical activity level increased by 1152.52 kcal week−1 (95% CI 703.73-1601.32) at 3 months with a sustained benefit (1279.10 kcal week−1, 95% CI 826.80-1731.40) after 12 months. Notably, baseline motivation to become physically active was not associated with change in physical performance or physical activity level during the programme. Conclusion: The 3-month step-up jogging programme is a feasible and effective exercise intervention for physically inactive, middle-aged female hospital staff members. The intervention leads to sustained benefits independently of motivation to become more physically activ

European Physician Survey Characterizing the Clinical Pathway and Treatment Patterns of Patients Post-Myocardial Infarction

Introduction: The 2019 European Society of Cardiology and European Atherosclerosis Society (2019 ESC/EAS) guidelines stress the importance of managing low-density lipoprotein cholesterol (LDL-C) after myocardial infarction (MI) to reduce the risk of cardiovascular events. Information on guideline implementation is limited. The aim of this survey was to describe current clinical practice regarding LDL-C management in the first year post-MI across Europe, improving understanding of the role of ESC/EAS guidelines on clinical practice. Methods: A qualitative web-based cross-sectional physician survey about the patient pathway and LDL-C management post-MI was conducted in 360 physicians from France, Italy, Germany, The Netherlands, Spain, and the UK (n = 60/country) between December 2019 and June 2020. Secondary and primary care physicians (SCPs/PCPs) described their experiences treating patients post-MI over the preceding 2months. Results: Physicians reported that on average 90.7% of patients not prescribed lipid-lowering therapy (LLT) before an MI initiated LLT as inpatients; for patients already taking LLT, treatment was intensified for 64.7% of inpatients post-MI. SCPs reported prescribing higher-intensity statins and/or ezetimibe for between 72.3% (Italy) and 88.6% (UK) of patients post-MI. More than 80.0% of SCPs and 51.2% of PCPs stated that they would initiate a change in LLT immediately if patients did not achieve their LDL-C treatment goal by 12weeks post-MI; 82.0% of SCPs and 55.1% of PCPs reported referring to 2019 ESC/EAS guidelines for management of patients post-MI. Barriers to initiating PCSK9 inhibitors (PCSK9is) included prior prescription of a maximally tolerated dose of statin (49.4%) and/or ezetimibe (38.9%), requirement to reach threshold LDL-C levels (44.9%), and pre-authorization requirements (30.4%). Conclusion: Differences in clinical practice post-MI were reported across the countries surveyed, including divergence between 2019 ESC/EAS and local guidelines. Increased use of innovative medicines to achieve LDL-C goals should reduce risk of subsequent cardiovascular events in very high-risk patients post-MI

The prevalence, low-density lipoprotein cholesterol levels, and treatment of patients at very high risk of cardiovascular events in the United Kingdom: a cross-sectional study

<p><b>Objective:</b> To assess the prevalence of patients at very high risk of cardiovascular (CV) events in the United Kingdom (UK) and evaluate low-density lipoprotein cholesterol (LDL-C) values and treatment patterns in these patients.</p> <p><b>Methods:</b> This cross-sectional study used primary care data from UK electronic medical records in the Clinical Practice Research Datalink (CPRD) in 2013. Very high-risk patients were defined per European Society of Cardiology guidelines as those with hyperlipidemia (assessed by co-medication) and documented cardiovascular disease (CVD) or hyperlipidemia and type 2 diabetes (DM2) without CVD (DM2w/oCVD). All analyses were descriptive.</p> <p><b>Results:</b> Data from 4,940,226 patients were captured in the CPRD in 2013. Of these, 5% of patients had received ≥2 lipid-modifying therapy prescriptions and were at very high risk of CVD (3% [<i>n</i> = 138,536] had documented CVD, 2% [<i>n = </i>98,743] had DM2w/oCVD). In documented CVD patients, coronary artery disease (73%) was the most frequent type of event (25% had myocardial infarction [MI]), followed by cerebrovascular disease (18%), and peripheral arterial disease (9%); 21% had experienced multiple CV events, 25% had DM2, and 3% had MI within 1 year. In documented CVD and DM2w/oCVD patients, >95% received statin treatment; 24% received high-intensity statin, and 1.5% statin plus ezetimibe. Across both populations, 64–66% had LDL-C levels ≥1.8 mmol/L, 27–28% ≥2.5 mmol/L, 6–7% ≥3.5 mmol/L, and 3% had levels ≥4.0 mmol/L, respectively.</p> <p><b>Conclusion:</b> A well-defined proportion of patients remain at very high-risk of CVD. Statin therapy needs optimization, but, for some patients with high LDL-C levels, multiple CV events, MI within 1 year, or CVD and DM2, additional more intensive therapy may be needed.</p

Association of Treatment Intensity and Adherence to Lipid-Lowering Therapy with Major Adverse Cardiovascular Events Among Post-MI Patients in Germany

Introduction Patients with a history of myocardial infarction (MI) are at very high risk of subsequent cardiovascular events. This study evaluated the association of treatment intensity and adherence to lipid-lowering therapies (LLT) with major adverse cardiovascular events (MACE) among post-MI patients in Germany. Methods We carried out a retrospective cohort study using German health claims data (2010-2015). We included patients >= 18 years, with a history of MI and who started an LLT (statin and/or ezetimibe), between 2011 and 2013. The follow-up period started 1 year after the second LLT prescription and continued until MACE, all-cause death or December 31, 2015, whichever occurred first. Treatment intensity was classified based on expected low-density lipoprotein cholesterol reduction; adherence was measured by the proportion of days covered using prescription data. A combined adherence-adjusted intensity variable was created by multiplying intensity and adherence. We used Cox proportional hazards models to control for age, sex, Charlson Comorbidity Index and other cardiovascular risk factors at baseline. Results A total of 14,944 patients were included. Mean age was 66.7 (SD = 13.0) years; 68.7% of patients were men. Each 10% increase in treatment intensity, adherence, or adherence-adjusted intensity was associated with a decrease in the risk of MACE of 17% (HR = 0.83, 95% CI 0.79-0.87), 5% (HR = 0.95, 95% CI 0.94-0.97), and 14% (HR = 0.86, 95% CI 0.83-0.90), respectively. Conclusions Higher treatment intensity and/or adherence of LLT was associated with significantly lower risk of MACE in post-MI patients. Strategies to tailor intensity to patient profiles and improve adherence could reduce the risk of cardiovascular events

Healthcare resource utilization, cardiovascular event rate and use of lipid-lowering therapies in secondary prevention of ASCVD in hospitalized patients in Italy

INTRODUCTION: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality in Italy, accounting for 22% of total deaths. Lowering low-density lipoprotein cholesterol (LDL-C) levels reduces the risk of cardiovascular (CV) events; thus, lipid-lowering therapy (LLT) is the first-line treatment for patients with ASCVD and hypercholesterolaemia. However, many patients with ASCVD fail to reach LDL-C treatment thresholds, leaving them at greater risk of CV events. Inpatient care accounts for 51% of total expenditure on cardiovascular disease in the European Union, but healthcare resource utilization (HCRU) data for ASCVD in Italy is limited. METHODS: The study analysed healthcare claims data for 17,881 patients with acute coronary syndrome, ischemic stroke or peripheral artery disease from the Umbria 2 and Marche regions of Italy. LLT treatment patterns and CV event rates were collected and HCRU estimated in the year before and after the index event. RESULTS: High-intensity LLTs were prescribed to 44.3% of patients and 49.6% received moderate-/low-intensity LLTs during the 6 months after the index event. The first year CV event rate was 18.0/100 patient-years for patients receiving high-intensity LLTs and 17.2/100 patient-years for those on moderate-/low-intensity LLTs. Higher costs were associated with patients untreated with LLT 6 months post-index event (€8323) than patients prescribed high-intensity (€6278) or moderate-/low-intensity LLTs (€6270). Hospitalization accounted for most of the total costs. CONCLUSIONS: This study found that CV events in secondary prevention Italian patients are associated with substantial HCRU and costs. More intensive LDL-C lowering can prevent CV events, easing the financial burden on the healthcare system. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12325-021-01960-y

Validity of a simple Internet-based outcome-prediction tool in patients with total hip replacement: a pilot study

We developed a user-friendly Internet-based tool for patients undergoing total hip replacement (THR) due to osteoarthritis to predict their pain and function after surgery. In the first step, the key questions were identified by statistical modelling in a data set of 375 patients undergoing THR. Based on multiple regression, we identified the two most predictive WOMAC questions for pain and the three most predictive WOMAC questions for functional outcome, while controlling for comorbidity, body mass index, age, gender and specific comorbidities relevant to the outcome. In the second step, a pilot study was performed to validate the resulting tool against the full WOMAC questionnaire among 108 patients undergoing THR. The mean difference between observed (WOMAC) and model-predicted value was -1.1 points (95% confidence interval, CI -3.8, 1.5) for pain and -2.5 points (95% CI -5.3, 0.3) for function. The model-predicted value was within 20% of the observed value in 48% of cases for pain and in 57% of cases for function. The tool demonstrated moderate validity, but performed weakly for patients with extreme levels of pain and extreme functional limitations at 3 months post surgery. This may have been partly due to early complications after surgery. However, the outcome-prediction tool may be useful in helping patients to become better informed about the realistic outcome of their THR