A prospective observational study on drug safety monitoring and Pharmacoeconomics in patients with locally advanced unresectable NSCLC in a tertiary care hospital

Background: Lung cancer is the deadliest type of cancer for both men and women. The study was aimed at learning and comparing the toxicities of various chemotherapeutic regimens for the treatment of carcinoma lung, which will help in the implementation of counter measures to avoid development of toxicities, with a constant vigil on the patients during chemotherapeutic cycles. This study also aimed at searching into the added economic burden to the unfortunate patient, who is already suffering from a deadly disease. Study also targeted at evaluating the performance status of the patients receiving the chemotherapy.Methods: The Adverse Drug Reactions (ADR) data was collected from 40 patients receiving chemotherapy for locally advanced unresectable carcinoma lung from the cancer wards of a tertiary care hospital over a period of 2 months. ADRs were graded according to WHO guidelines and their performance statuses were assessed using the Zubrod’s performance scale. Cost analysis of chemotherapeutic regimens was also carried out.Results: On comparison, alopecia and peripheral neuropathy were significantly more common with carboplatin-paclitaxel combination compared to other regimens (p value<0.005). Cost analysis reveals that the most commonly employed carboplatin-paclitaxel combination is more affordable when compared to the newer highly expensive agents but is costlier than cisplatin based chemotherapy. Also, carboplatin-paclitaxel combination offers a reasonably good performance status.Conclusions: Thus, carboplatin-paclitaxel combination is the preferred regimen for palliation in advanced NSCLC, especially in the older patients

Finerenone: A New Era for Mineralocorticoid Receptor Antagonism and Cardiorenal Protection.

The renin-angiotensin-aldosterone system is a neurohormonal system responsible for maintaining homeostasis of fluid regulation, sodium balance, and blood pressure. The complexity of this pathway enables it to be a common target for blood pressure and volume-regulating medications. The mineralocorticoid receptor is one of these targets, and is found not only in the kidney, but also tissues making up the heart, blood vessels, and adipose. Mineralocorticoid receptor antagonists have been shown to slow progression of chronic kidney disease, treat refractory hypertension and primary aldosteronism, and improve morbidity and mortality in management of heart failure with reduced ejection fraction. The more well-studied medications were derived from steroid-based compounds, and thus come with a distinct side-effect profile. To avoid these adverse effects, developing a mineralocorticoid receptor antagonist (MRA) from a non-steroidal base compound has gained much interest. This review will focus on the novel non-steroidal MRA, Finerenone, to describe its unique mechanism of action while summarizing the available clinical trials supporting its use in patients with various etiologies of cardiorenal disease

Nuclear Imaging for the Assessment of Cardiotoxicity from Chemotherapeutic Agents in Oncologic Disease

PURPOSE OF REVIEW: In this review, we summarize the major known cardiac toxicities of common chemotherapeutic agents and the role of nuclear cardiac imaging for the surveillance and assessment of cancer therapeutics-related cardiac dysfunction in routine clinical practice. RECENT FINDINGS: Cardiotoxicity from chemotherapy causes a significant mortality and limits potentially life-saving treatment in cancer patients. Close monitoring of cardiac function during chemotherapy is an accepted method for reducing these adverse effects especially in patients with cancer therapeutics-related cardiac dysfunction. Nuclear imaging is a sensitive, specific, and highly reproducible modality for assessment of cardiac function. Nuclear imaging techniques including equilibrium radio nucleotide angiography, myocardial perfusion imaging, and novel experimental molecular imaging are the various objective tools available in addition to conventional echocardiography and cardiac magnetic resonance imaging in the surveillance, assessment, and follow-up of cancer therapeutics-related cardiac dysfunction

Heart Failure With Preserved Ejection Fraction: Key Stumbling Blocks for Experimental Drugs in Clinical Trials

INTRODUCTION: Heart failure with preserved ejection fraction (HFpEF) is a disease with a high prevalence. Accounting for more than 50% of all heart failure cases, it carries a significant mortality. There is a lack of therapeutic options that show improvement in morbidity and mortality. Certain novel therapies have shown a decrease in heart failure hospitalizations; however, this beneficial effect was more pronounced for heart failure patients with mildly reduced ejection fraction (EF). AREAS COVERED: This review summarizes the pathophysiology of the disease to help elucidate the differences between heart failure with reduced ejection fraction (HFrEF), and HFpEF, which could explain why therapies are successful in one (rather than the other). This review focuses on non-standardized nomenclature across major trials, the challenges of finding a therapeutic agent for such a heterogeneous population, and identification of specific phenotypes that have different outcomes and could be a target for future therapies. EXPERT OPINION: Lack of standardized diagnostic criteria, associated with population heterogeneity, might explain why trials have failed to improve outcomes for patients with HFpEF. Standardizing phenotypes, recapitulating these phenotypes in animal models, and understanding the mechanisms of the disease at the molecular level could be the first steps in identifying promising therapeutic options

Mental Health Disorders and Readmissions Following Acute Myocardial Infarction in the United States

Hospital readmissions following an acute myocardial infarction (MI) are associated with increased mortality and morbidity. The aim of this study was to investigate if there is a significant association between specific mental health disorders (MHD) and risk of hospital readmission after an index hospitalization for acute MI. We analyzed the U.S. National Readmission Database for adult acute MI hospitalizations from 2016 to 2017. Co-morbid diagnoses of MHD were obtained using appropriate ICD-10-CM diagnostic codes. The primary outcome of interest was 30-day all-cause unplanned readmission. Cox-regression analysis was used to identify the association of various MHD and risk of 30-day readmission adjusted for demographics, medical and cardiac comorbidities, and coronary revascularization. We identified a total of 1,045,752 hospitalizations for acute MI; patients had mean age of 67 ± 13 years with 37.6% female. The prevalence of any MHD was 15.0 ± 0.9%. After adjusting for potential confounders, comorbid diagnosis of major depression [HR 1.11 (95% CI 1.07-1.15)], bipolar disorders [1.32 (1.19-1.45)], anxiety disorders [1.09 (1.05-1.13)] and schizophrenia/other psychotic disorders [1.56 (1.43-1.69)] were independently associated with higher risk of 30-day readmission compared to those with no comorbid MHD. We conclude that MHD are significantly associated with a higher independent risk of 30-day all-cause hospital readmissions among acute MI hospitalizations

The role of serial right heart catheterization in risk stratification and management of pulmonary arterial hypertension.

INTRODUCTION: Pulmonary arterial hypertension (PAH) is characterized by elevated pulmonary arterial blood pressure secondary to increased pulmonary vascular resistance. AREAS COVERED: Invasive hemodynamic assessment by heart catheterization (RHC) remains the gold standard to confirm the diagnosis, to determine the severity of right ventricular dysfunction and to test for pulmonary vasoreactivity. After diagnosis and initiation of therapy, many PAH centers continue to perform RHC at regular intervals to monitor for disease progression and alter management. We discuss the importance of risk stratification in PAH, the role of RHC in the evaluation and treatment of these patients and compare non-invasive risk assessment tools to that of RHC. EXPERT OPINION: RHC is useful for diagnosis of PAH, assessing the risk of mortality and morbidity, directing the escalation and de-escalation of therapy, and monitoring for disease progression. In the current era of improved non-invasive cardiac hemodynamic assessment, the role for routine follow-up serial RHC in patients with PAH needs to be reassessed in future studies. With the availability of non-invasive risk assessment tools such as REVEAL Lite 2, it may be reasonable to reconsider the role of annual or protocoled RHC, and instead, move on to an as needed and individual approach

Trends in 10-Year Predicted Risk of Cardiovascular Disease Associated With Food Insecurity, 2007-2016

INTRODUCTION: Consumption of a healthy diet improves cardiovascular (CV) risk factors and reduces the development of cardiovascular disease (CVD). Food insecure (FIS) adults often consume an unhealthy diet, which can promote obesity, type 2 diabetes mellitus (T2DM), hypertension (HTN), and hyperlipidemia (HLD). The Supplemental Nutrition Assistance Program (SNAP) is designed to combat food insecurity by increasing access to healthy foods. However, there is a paucity of data on the association of SNAP participation among FIS adults and these CVD risk factors. METHODS: The National Health and Nutrition Examination Survey (NHANES) is a publicly available, ongoing survey administered by the Centers for Disease Control and Prevention and the National Center for Health Statistics. We analyzed five survey cycles (2007-2016) of adult participants who responded to the CVD risk profile questionnaire data. We estimated the burden of select CVD risk factors among the FIS population and the association with participation in SNAP. RESULTS: Among 10,449 adult participants of the survey, 3,485 (33.3%) identified themselves as FIS. Food insecurity was more common among those who were younger, female, Hispanic, and Black. Among the FIS, SNAP recipients, when compared to non-SNAP recipients, had a lower prevalence of HLD (36.3 vs. 40.1% = 0.02), whereas rates of T2DM, HTN, and obesity were similar. Over the 10-year survey period, FIS SNAP recipients demonstrated a reduction in the prevalence of HTN ( \u3c 0.001) and HLD ( \u3c 0.001) which was not evident among those not receiving SNAP. However, obesity decreased only among those not receiving SNAP. The prevalence of T2DM did not change over the study period in either group. CONCLUSION: Over a 10-year period, FIS adults who received SNAP demonstrated a reduction in the prevalence of HTN and HLD, which was not seen among those not receiving SNAP. However, the prevalence of obesity and T2DM did not decline among SNAP recipients, suggesting that additional approaches are required to impact these important CVD risk factors

SGLT2 inhibitors in hypertension: Role beyond diabetes and heart failure

Type 2 Diabetes Mellitus (T2DM) is a pandemic that affects millions of patients worldwide. Diabetes affects multiple organ systems leading to comorbidities including hypertension. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) recently have been approved for the treatment of T2DM and heart failure with reduced and preserved ejection fraction. Retrospective analyses of clinical trials have noted SGLT2 inhibitors to have a promising effect on blood pressure. Moreover, the observed blood pressure reduction is not just an acute effect of treatment initiation but has been shown to have a long-term impact on both systolic and diastolic blood pressure. The mechanism of action leading to the blood pressure reduction is still unclear; however, proposed mechanisms are related to the natriuretic effect, modification of the renin-angiotensin-aldosterone system, and/or the reduction in the sympathetic nervous system, SGLT2i should be considered as second-line medication in those patients with diabetes or heart disease and concomitant hypertension. This article reviews the pharmacology, side effect profile, and clinical trials surrounding the use of SGLT2i for the treatment of hypertension