Clinical outcomes of high-intensity doses of atorvastatin in patients with acute coronary syndrome: A retrospective cohort study using real-world data.

AIMS: To compare the effectiveness and safety of 2 high-intensity atorvastatin doses (40 mg vs 80 mg) among acute coronary syndrome (ACS) patients. METHODS: This retrospective observational cohort study using real-world data included patients admitted with ACS to the Heart Hospital in Qatar between 1 January 2017 and 31 December 2018. The primary endpoint was a composite of cardiovascular disease-associated death, nonfatal ACS and nonfatal stroke. Cox proportional hazard regression analysis was used to determine the association between the 2 high-intensity atorvastatin dosing regimens and the primary outcome at 1 month and 12 months postdischarge. RESULTS: Of the 626 patients included in the analyses, 475 (75.9%) received atorvastatin 40 mg, while 151 (24.1%) received atorvastatin 80 mg following ACS. Most of the patients were Asian (73%), male (97%) with a mean age of 50 years and presented with ST-elevation myocardial infarction (60%). The incidence of the primary effectiveness outcome did not differ between the atorvastatin 40-and 80-mg groups at 1 month (0.8 vs 1.3%; adjusted hazard ratio = 0.59, 95% confidence interval 0.04-8.13, P = .690) and at 12 months (3.2 vs 4%; adjusted hazard ratio = 0.57, 95% confidence interval 0.18-1.80, P = .340). Similarly, the use of the 2 doses of atorvastatin resulted in comparable safety outcomes, including liver toxicity, myopathy and rhabdomyolysis with an event rate of <1% in both groups. CONCLUSION: The use of atorvastatin 40 mg in comparison to atorvastatin 80 mg in patients with ACS resulted in similar cardiovascular effectiveness and safety outcomes.

Medications adherence post-primary percutaneous coronary intervention in acute myocardial infarction: A population-based cohort study.

WHAT IS KNOWN AND OBJECTIVE: The use of medications for secondary prevention is the cornerstone in the treatment of coronary artery disease (CAD). However, adherence to these medications is still suboptimal worldwide. This retrospective observational study aimed to assess the adherence to post-percutaneous coronary intervention (PCI) medications, along with predictors of non-adherence. METHODS: We conducted a retrospective observational cohort study to assess the adherence to post-PCI medications by determining the rate of prescription refills for 12 months after discharge among STEMI patients, as well as predictors of non-adherence. Adherence was assessed by medication availability 80% of the time monitored by the prescription refills rate for 1 year post-discharge. RESULTS AND DISCUSSION: A total of 1334 patients who presented with STEMI and underwent primary PCI were included in our retrospective analysis. The majority of patients included were male (96%) with a mean age of 51 ± 10.2 years. The overall adherence rate for all medications was only 28.4%, with an individual adherence rate of 50.5% for aspirin, 49.9% for P2 Y12 inhibitors, 48.1% for statins, 39.6% for beta-blockers and 42.9% for angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB). Factors that increased the likelihood of non-adherence were prolonged hospital length of stay and getting the medications with charge (aOR = 1.94, 95% CI 1.1-3.3; p-value = 0.017, aOR = 1.87, 95% CI 1.1-3.3; p-value = 0.029, respectively), while having a regular follow-up after discharge and attending the first clinic appointment were significantly associated with decreased likelihood of non-adherence (aOR = 0.01, 95% CI 0.004-0.04; p-value < 0.001, aOR = 0.06, 95% CI 0.03-0.1; p-value < 0.001, respectively). WHAT IS NEW AND CONCLUSION: The adherence rate to post-PCI medications among patients with STEMI was relatively low; however, attending the first outpatient clinic appointment and having a regular follow-up reduced the likelihood of non-adherence.

Nurses' perceptions of and satisfaction with the use of automated dispensing cabinets at the Heart and Cancer Centers in Qatar: a cross-sectional study.

BACKGROUND: Automated dispensing cabinets (ADCs) were introduced in 2010 and 2012 at the Heart Hospital (HH) and National Center for Cancer Care and Research (NCCCR), both run by Hamad Medical Corporation in Qatar. These medication distribution systems provide computer-controlled storage, dispensing, and tracking of drugs at the point of care in patient care units. The purpose of this study was to assess nurses' perceptions of and satisfaction with the use of ADCs at HH and NCCCR. METHODS: A cross-sectional study was conducted in the two institutions in May and November 2012 using a piloted, validated, online, and anonymous questionnaire. The questionnaire consisted of four parts: nurses' sociodemographic and practice characteristics, 21 questions about their perceptions, one question about their overall satisfaction, and one about the system's ease of use. The self-administered survey was distributed to 503 nurses working at HH and NCCCR over three weeks using Survey Monkey®. RESULTS: The survey response rate was 80 % (n = 403). No significant difference was found in perception scores between the two institutions (p = 0.06). Ninety-four percent (n = 378) of nurses agreed that the medication delivery system allowed them to do their job more safely, and 90 % (n = 363) nurses agreed that they now spent less time waiting for medication from the pharmacy than they did before the ADC system was introduced. Eighty seven percent (n = 349) nurses agreed that they were able to administer medication more efficiently with the ADC system. The overall satisfaction rate (either "very satisfied" or "satisfied") for the two hospitals was 91 %. CONCLUSIONS: The nurses' perceptions of and levels of satisfaction with the ADC system were very good over the 6 months after complete implementation and integration at HH and NCCCR. ADCs appear to increase efficiency in the medication process and should therefore improve the quality of care.

Appropriateness and clinical outcomes of short sustained low-efficiency dialysis: A national experience.

Sustained low-efficiency dialysis (SLED) is usually performed over 6-12 h among hemodynamically unstable patients. Conduction of 4-h SLED may spare time and manpower during hospitalization. Therefore, we conducted a retrospective observational study to explore the appropriateness and clinical outcomes of 4-h SLED among critically ill patients admitted to our center from 1/06/2016 to 1/06/2020. Renal parameters including blood urea nitrogen, serum creatinine, sodium, phosphorus, potassium, and bicarbonate were determined on the day of dialysis before SLED and within 24 h after SLED, and clinical outcomes including, acute kidney injury (AKI) recovery, in-hospital mortality, 30-day mortality, 180-day mortality, and re-admission with AKI, were evaluated. Of the 304 patients included, 69.4% were male. The majority of patients were from the Middle East (65.8%), followed by 28.6% from Asia. Four-hour SLED resulted in a significant improvement in the renal parameters. Recovery from AKI was observed in 25.4%, in-hospital mortality rate was 48.7%, while the 30- and 180-day mortality outcomes were 3.2 and 9.6%, respectively, and re-admission with AKI was observed in 16.9%. Our findings suggest that 4-h SLED significantly improved renal parameters and was associated with favorable clinical outcomes in terms of survival and AKI recovery, suggesting possible utilization of SLED shorter than 6 h in the acute settings to preserve time and manpower for procedures.

Surrogates of the Left Ventricular Thrombus Resolution: A Retrospective Data Review.

OBJECTIVE: The left ventricular thrombus is one of the serious complications of ischemic cardiomyopathy. In this study, we aimed to search for the independent factors to predict the resolution of left ventricular thrombus. METHODS: This retrospective study included all patients with coronary artery disease, aged above 18 years old, and with the thrombus at the apical location of the left ventricle. Demographic, clinical, and echocardiographic characteristics of the patients were recorded. Major adverse cardiovascular events developed within the follow-up period were recorded. The time in the therapeutic range of each patient was calculated. The presence of left ventricular thrombus beyond 180 days despite warfarin usage was classified as persistent left ventricular thrombus. RESULTS: The study included 174 subjects (169 males and 5 females). The mean age of the study population was 54.5 ± 11.0 years. The number of patients in whom the left ventricular thrombus resolved with treatment in less than 180 days was 56 (32.2%). Median anticoagulation time in the study population was 252 [150-480] days and the meantime in the therapeutic range of the patients was 54 ± 19%. The time in therapeutic range value of the groups was similar (P=.593). It was found that concomitant clopidogrel use (P=.003) and left ventricular thrombus area (P < .001) were the independent predictors of left ventricular thrombus resolution within less than 180 days in the logistic regression analysis. CONCLUSION: Concomitant use of clopidogrel was found to be associated with left ventricular thrombus resolution but left ventricular thrombus size was related to left ventricular thrombus persistency. Although standard 3-6 months of anticoagulation is advised for left ventricular thrombus, considering the presence of these predictors in such patients may guide the physicians to individualize the treatment.

The Role of Coronary Computed Tomography Angiography in Evaluation of High Troponin Patients with Narrow-Complex Supraventricular Tachycardia.

Aim: The aim of this study was to investigate the relation of high-sensitive cardiac troponin T (hs-cTnT) elevation with characteristics of supraventricular tachycardia (SVT) episode (duration and maximum heart rate) and coronary computed tomography angiography (CCTA) findings in patients with SVT who presented to the emergency room with palpitation. Methods: This retrospective, single-center, noninvasive study included all patients aged between 18 years and 65 years who presented to the emergency department due to narrow-complex SVT and underwent CCTA to rule out coronary artery disease (CAD) due to elevation of hs-cTnT and reverted back to sinus rhythm after intravenous adenosine. The first, second, and the maximum hs-cTnT levels were obtained from the database. The patients were classified into normal coronaries, nonobstructive CAD, and obstructive CAD according to findings of the CCTA. The findings of the groups were compared. Results: Eighty-five patients were enrolled in the study. Of them, 21 (26%) patients were female. Sixty-three patients (74%) had normal coronary arteries as per CCTA results, whereas 22 patients (22%) had nonobstructive CAD and two patients (2%) had obstructive CAD. The groups did not differ statistically in respect to hs-cTnT measurements, duration of the arrhythmia, and maximum heart rate at SVT episode. There was no significant statistical correlation between hs-cTnT and the study parameters except the maximum heart rate. Conclusion: Cardiac troponins may increase in patients with paroxysmal SVT irrespective of the presence of coronary lesions, and the CCTA may not be an appropriate investigation in the differential diagnosis of paroxysmal SVT with elevated hs-cTnT.

Medication risk communication with cancer patients in a Middle East cancer care setting.

PURPOSE: Cancer treatments are frequently associated with adverse effects, but there may be a cultural reluctance by care providers to be forthcoming with patients regarding these risks for fear of promoting nonadherence. Conversely, research in a number of countries indicates high levels of patient desire for this information. We sought to explore cancer patient experiences, satisfaction, and preferences for medication risk communication in a Middle East care setting. METHODS: We developed and administered a ten-item questionnaire (Arabic and English) to a convenience sample of consenting adult patients receiving treatment at the National Center for Cancer Care and Research in Qatar. RESULTS: One hundred and forty-three patients were interviewed. Most (88%) stated that the level of side effect information they received was sufficient, with physicians (86%) followed by pharmacists (39%) as the preferred sources. The majority (97%) agreed that knowing about possible side effects would help them recognize and manage the reaction, and 92% agreed that it would help them understand how to minimize or prevent the risks. Eighteen percent indicated that this information would make them not want to take treatment. Two-thirds (65%) had previously experienced intolerance to their cancer treatment regimen. CONCLUSION: Most patients surveyed expressed preference for the details of possible side effects they may encounter in their treatment. However, one in five considered such information a factor for nonadherence, indicating the need for patient-specific approaches when communicating medication risks.

Risk communication with Arab patients with cancer: a qualitative study of nurses and pharmacists.

OBJECTIVES: To explore pharmacist and nurse views and experiences in educating patients regarding their treatment safety and tolerability as well as the roles of other professions in this regard. DESIGN: In this qualitative study, six focus group discussions were conducted. SETTING: The National Center for Cancer Care and Research in Qatar. PARTICIPANTS: Eleven pharmacists and 22 nurses providing direct patient care. RESULTS: Concepts related to three key themes were drawn from the seeding questions and included factors for determining the level of risk they communicated: the specific treatment regimen in question; the patient; and their assessment of the patient. Patient-related considerations arose from additional subthemes; both nurses and pharmacists described aspects related to the perceived psychological health status of the patient, as well as anticipated comprehension, as ascertained by demonstrated education and language abilities. In all discussions, it was noted that physician and family non-disclosure of cancer diagnosis to the patient profoundly influenced the nature of information they provided. While a high level of cohesion in safety communication prioritisation among these two health disciplines was found, a number of pharmacists asserted a more formal role compared to informal and repeated teaching by nurses. CONCLUSIONS: Nurses and pharmacists in this Middle East healthcare environment were not reluctant to discuss treatment side effects with patients and draw on similar professional judgements in prioritising treatment risk information. We found that they did not always recognise each other's informal educational encounters and that there are opportunities to explore increased collaboration in this regard to enhance the patient care experience.

Severe hypophosphatemia induced after first cycle of the ESHAP protocol for Hodgkin's lymphoma: a case report.

The effect of the ESHAP (etoposide, methylprednisolone, cytarabine, cisplatin) salvage protocol on serum electrolytes has been previously reported by individual observational studies. The most commonly described electrolyte affected by the ESHAP protocol is magnesium. In addition, hypophosphatemia has been studied and reported as a complication of cisplatin therapy, although it is usually asymptomatic. This is a case report of a 51-year-old woman with relapsed Hodgkin's lymphoma who developed severe hypophosphatemia following administration of the first cycle of the ESHAP protocol. The patient started to develop gradually decreasing phosphate levels 2 weeks after receiving chemotherapy, which needed to be corrected by phosphate supplementation. This case report raises concern regarding hypophosphatemia as a possible side effect of the ESHAP protocol and points to a need for close monitoring, taking into consideration vitamin D levels, urinary phosphate excretion, parathyroid hormone levels, and arterial blood gas analysis to rule out other contributing factors. Health care providers should be made aware of this possible toxicity. Critical monitoring of phosphate levels and considering supplementation is warranted with the ESHAP protocol, especially when it is used in combination with granulocyte colony-stimulating factor and diuretics, to prevent such possible hypophosphatemia. Further investigations may be required to confirm and evaluate the significance of this type of toxicity.