ANALYZES OF ANTIPLATELETS AND ANTICOAGULANTS UTILIZATION IN PATIENTS TREATED IN CARDIOVASCULAR REHABILITATION CENTER FROM CROATIA

Purpose: Discordance with the guidelines and underutilization of pharmacotherapy for secondary prevention frequently exists in clinical practice. Aim of our study was to assess the prescription routine and drug utilization patterns for antiplatelets and peroral anticoagulants in tertiary medical center specialized for cardiovascular rehabilitation. Methods: study included 96 consecutive patients scheduled for cardiovascular rehabilitation in period 1-6 months after the acute treatment for ischemic 87(80.2%) and valvular heart disease 18(19.8%). Patients were divided according to etiology of heart disease and type of acute cardiovascular treatments (conservative, percutaneous coronary interventions (PCI) and surgery). Results: Dual antiplatelet therapy was the most commonly applied regimen in 84(87.5%) of conservatively treated myocardial infarctions, 47(61.9%) of percutaneous coronary interventions (PCI) and 13(58.9%) of surgically treated group (p>0.05). Among studied group of patients significant differences in utilization were found for warfarin, or combinations of antiplatelets with warfarin(p<0.001), as well as studied etiologies of heart disease(p<0.001), whilst there were no differences for those groups for studied antiplatelets drugs(p>0.05). All four of patients that received triple therapy (4.17%) were from surgical group. Underutilization of antiplatelets in ischemic heart disease was at 11(14.3%) what was congruent with the developed industrial nations. Conclusions: Acute cardiovascular treatment type, but not heart disease etiology, had significant influence on subsequent prescription routine. Decreased use of pharmacological agents for secondary prevention in surgical patients was revealed. Drug utilization analyzes can offer improvement in optimizing medical treatments, quality of care and decrease unnecessary polypragmasia, as well as improve economical efficiency of medical management

Związek między stanem odżywienia a stosowaniem inhibitorów pompy protonowej u pacjentów poddawanych rehabilitacji kardiologicznej po leczeniu niedokrwiennej i zastawkowej choroby serca

Background: Multiple and yet uncertain connections exist between cardiovascular diseases and the nutritional status of patients, particularly in relation to cardiovascular treatments. Proton pump inhibitors (PPI) are among the most commonly used group of drugs. Aim: To analyse utilisation of PPI in association with nutritional risk of patients scheduled for rehabilitation after treatment for ischaemic and valvular heart disease. Methods: Retrospective analyses on a consecutive sample of patients, which included drug utilisation of PPI and nutritional risk screening, using a standardised NRS-2002 tool. The patients (n = 536) were divided into groups based on previous cardiovascular treatments and use of PPI. Results: Nearly half of the patients (244, 46.1%) had PPI in their chronic therapy despite the clinically negligible prevalence of conditions that are their fundamental indications. The odds for using PPI in patients with increased nutritional risk, estimated by logistic regression, were 3.34 (95% confidence intervals [CI] 2.26–4.94), p &lt; 0.001. Receiver operating curve analyses also revealed significant differences of PPI utilisation in connection with NRS-2002 &gt; 3: positive likelihood-ratio (LR) 2.35 (95% CI 2.10–2.60); negative LR 0.46 (95% CI 0.4–0.6); area under the curve (AUC) 0.720; p &lt; 0.001; as well as the percentage weigh loss history &gt; 6.36% (positive LR 2.22 [95% CI 2.00–2.50]; negative LR 0.41 [95% CI 0.30–0.50]; AUC 0.707; p &lt; 0.001). Conclusions: Utilisation of PPI was found to be of relatively high prevalence and significantly associated with parameters of nutritional risk screening. Furthermore, it was in correlation with the age of patients and the existence of chronic kidney disease, which are well-established predispositions for poor nutritional status. Nutritional risk seems to be additionally negatively challenged by utilisation of PPI due to gastric malabsorption and anaemia.Wstęp: Istnieją liczne i nieustalone w pełni powiązania między chorobami sercowo-naczyniowymi a stanem odżywienia chorych, zwłaszcza w przypadku stosowania leków działających na układ sercowo-naczyniowy. Do grupy najczęściej wykorzystywanych preparatów należą inhibitory pompy protonowej (PPI). Cel: Celem badania było przeanalizowanie zależności między stosowaniem PPI a ryzykiem związanym ze stanem odżywienia pacjentów poddawanych rehabilitacji kardiologicznej po leczeniu choroby niedokrwiennej i zastawkowej serca. Metody: Przeprowadzono retrospektywną analizę kolejnych prób chorych obejmującą stosowanie PPI i badanie przesiewowe w kierunku ryzyka związanego ze stanem odżywienia, wykorzystując wystandaryzowane narzędzie NRS-2002. Pacjentów (n = 536) podzielono na grupy w zależności od wcześniejszego leczenia chorób sercowo-naczyniowych i stosowania PPI. Wyniki: Prawie połowa chorych (244 osoby, 46,1%) przyjmowała PPI w ramach długookresowej terapii, mimo że zaburzenia stanowiące podstawowe wskazania do ich stosowania występowały u niewielkiego (nieistotnego klinicznie) odsetka badanych. Prawdopodobieństwo stosowania PPI u chorych obciążonych zwiększonym ryzykiem związanym ze stanem odżywienia oszacowane metodą regresji logistycznej wynosiło 3,34 (95% przedział ufności [CI] 2,26–4,94), p &lt; 0,001. Analiza krzywej ROC również wykazała istotną różnicę w stosowaniu PPI w związku z NRS-2002 &gt; 3: iloraz prawdopodobieństwa (LR) otrzymania wyniku dodatniego: 2,35 (95% CI 2,10–2,60); LR otrzymania wyniku ujemnego: 0,46 (95% CI 0,4–0,6); pole pod krzywą (AUC): 0,720; p &lt; 0,001; oraz procentowa utrata masy ciała &gt; 6,36% (LR wyniku dodatniego: 2,22 [95% CI 2,00–2,50]; LR wyniku ujemnego: 0,41 [95% CI 0,30–0,50]; AUC: 0,707; p &lt; 0,001. Wnioski: Stwierdzono, że leki z grupy PPI były wykorzystywane stosunkowo często. Terapia tymi preparatami wiązała się istotnie z parametrami oceny ryzyka związanego ze stanem odżywienia, a także korelowała z wiekiem pacjentów i obecnością przewlekłej choroby nerek, będących uznanymi czynnikami predysponującymi do złego stanu odżywienia. Wydaje się, że stosowanie PPI dodatkowo zwiększa ryzyko związane ze stanem odżywienia ze względu na zmniejszenie wchłaniania w żołądku i niedokrwistość

Muscle strength differ between patients with diabetes and controls following heart surgery

The aim of our study was to analyze muscle strength in patients with recent surgical treatment for ischemic and combined ischemic- valvular heart disease, based on existence of diabetes mellitus. Connections existing between muscle strength and patient characteristics or conventional diagnostic tests were analyzed as well. Study prospectively included consecutive patients scheduled for cardiovascular rehabilitation 0–3 months after heart surgery. Diagnostics covered drug utilization, anthropometrics, demographics, echocardiography, conventional laboratory, echocardiography, bioelectrical impedance analysis (BIA), and hand grip test (HGT). HGT was analyzed for dominant hand. Patients with diabetes had significantly weaker muscle strength on HGT than controls ; 29.4 ± 12.2 kg vs. 38.2 ± 14.7 kg (p = 0.029), respectively. ROC analysis for HGT and existence of diabetes mellitus were significant ; ≤ 40 kg had sensitivity of 89.7% (95%CI: 72.6–97.8), specificity 43.7% (31.9– 56.0) ; AUC 0.669 (0.568–0.760) ; p = 0.002. HGT significantly correlated with hematocrit (Rho CC = 0.247 ; p = 0.013), whilst other laboratory or echocardiographic parameters were insignificant (all p > 0.05). HGT also correlated with body weight (Rho CC = 0.510 ; p < 0.001) ; height (Rho CC = 0.632 ; p < 0.001) ; waist circumference (Rho CC = 0.388 ; p < 0.001) ; waist-to-hip ratio (Rho CC = 0.274 ; p = 0.006) and BIA (Rho CC = − 0.412 ; p < 0.001). In postoperative recovery of patients with diabetes, muscle strength assessed by HGT is decreased and in relation with nutritional status. Clinically resourceful connections of HGT were also found to hematocrit and utilization of loop diuretics