Statin Adherence and Mortality in Patients Aged 80 Years and Older After Acute Myocardial Infarction.

BACKGROUND/OBJECTIVES: The goal of this study was to describe the pattern of statin adherence in older patients, aged 80 years or older; identify factors associated with high adherence; and determine the association between statin adherence and all-cause mortality. DESIGN: Retrospective population-based cohort study. SETTING: An integrated healthcare system in Southern California. PARTICIPANTS: Patients hospitalized with a principal diagnosis of acute myocardial infarction (MI) between January 1, 2006, and December 31, 2016. MEASUREMENTS: Statin adherence, as measured using pharmacy dispensing records over the 365 days following hospital discharge, based on proportion of days covered (PDC). Adherence levels were categorized as high (PDC 80% or higher), partial (PDC 40% or higher and lower than 80%), and low (PDC lower than 40%). RESULTS: Between 2006 and 2016, 5629 patients, 80 years or older, hospitalized for acute MI met the inclusion criteria. Among this group, 68.8% were highly adherent to statin therapy, 20.4% were partially adherent, and 10.8% were not adherent. Male sex (odds ratio [OR] = 1.42; 95% confidence interval [CI] = 1.25-1.62) and white race (OR = 1.35; 95% CI = 1.18-1.55) were associated with high statin adherence. Follow-up was 4.3 ± 2.6 years. Both low and partial adherence were associated with increase mortality (low adherence: adjusted hazard radio [HR] = 1.12; 95% CI = 1.01-1.25; partial adherence: adjusted HR = 1.22; 95% CI = 1.12-1.32). CONCLUSIONS: In older patients, aged 80 years or older, high adherence to statins after MI was associated with improved survival. This association may not have been due only to adherence to statins but to other related factors as well. Findings from this study may inform discussions on the potential benefits of statin adherence. J Am Geriatr Soc 67:2045-2049, 2019.

Pregnancy-related mortality in southern Nepal between 2001 and 2006: independent estimates from a prospective, population-based cohort and a direct sisterhood survey.

Demographic household surveys in Nepal between 1996 and 2006 indicate potentially large decreases in the pregnancy-related mortality ratio and raise hopes that Nepal may be on track to meet Millennium Development Goal 5. Between 2002 and 2006, 23,478 pregnant women in Sarlahi District, Nepal, were followed through pregnancy to 42 days postpartum. The pregnancy-related mortality ratio (PRMR) was estimated directly, comparing deaths among women during pregnancy or within 42 days of pregnancy termination to livebirths. In a separate household survey, 13,319 married females reported on the pregnancy history of 28,829 sisters, allowing for a concurrent comparison of estimation methodologies. In the prospective study, there were 121 pregnancy-related deaths and 23,662 livebirths (PRMR = 511, 95% confidence interval: 425, 611). In the household survey, participants reported 396 deaths among sisters, 87 (22.0%) of which were pregnancy related, and 116,491 person-years of exposure (PRMR = 529, 95% confidence interval: 419, 638). Two independent estimates collected with different methods in the same geographic area over similar time periods resulted in similarly high estimates of mortality that are approximately twice the current national estimate. Access to life-saving maternal health interventions remains low in rural Nepal, and continued efforts are necessary to ensure equitable and country-wide progress toward Millennium Development Goal 5.

Compassion satisfaction, compassion fatigue, and critical incident stress management.

This study examines the potential for compassion satisfaction, compassion fatigue, and burnout in a sample of persons attending a workshop on Prevention of Compassion Fatigue at an international conference of providers of Critical Incident Stress Management (CISM) services. In the study, more than half (58%) of the respondents reported experiencing psychological reactions after providing CISM services, including an array of behavioral, emotional, cognitive, and physical symptoms of psychological stress. Forty percent of respondents were found to have moderate, high, or extremely high risk for compassion fatigue. At the same time, 89% of respondents were found to have a good, high, or extremely high potential for compassion satisfaction, and 87% were found to be at extremely low risk for burnout. The results appear to indicate that, while the CISM practitioners recognize the stress associated with their work (as reflected in the reported symptoms), the work provides significant rewards (as measured by compassion satisfaction) that outweigh the stress and mitigate against burnout. Likewise, while 40% tested positive for compassion fatigue (or secondary traumatic stress) as a result of their empathy with CISM recipients, the rewards of the work again appear to mitigate the negative effects of the work. Implications for future research and practice are presented.