Risk Assessment of the Cardiac Pregnant Patient.

Women with heart disease are at increased risk for maternal and fetal complications in pregnancy. Therefore, all women with heart disease should undergo evaluation and counseling, ideally before conception, or as early in pregnancy as possible. In this article we will review the role of risk assessment, the history of development of the cardiac risk prediction tools, and the role of current cardiac risk prediction tools.

Sample closet medications are neither novel nor useful.

BACKGROUND: Many physicians dispense drug samples in their offices, but this practice may not benefit patients. We analyzed the novelty and usefulness of the medications most commonly found in sample closets in primary care practices. METHODS: In this cross-sectional study, we inventoried 10 sample closets from internal medicine and family practice offices in the Phoenix metropolitan area. We analyzed 23 medications found in 7 or more closets. To assess novelty, we determined whether the sample medication had a new mechanism of action, a generic version with the same mechanism of action on the market, and a generic medication for the same indication on the market. To assess usefulness, we determined whether the sample medication improved patient-oriented outcomes, safety, and tolerability. We noted the cost of a 1-month supply for a typical starting dose. RESULTS: Ninety-six percent (n = 22) of sample closet medications had a generic medication for the same indication and 74% (n = 17) had a generic medication with the same mechanism available on the market. Only 3 medications (13%) had evidence of superior patient-oriented outcomes when compared with other medications for the same indication. Six medications (26%) demonstrated superior safety or tolerability. Only one medication (4%) was recommended as a first-line therapy in an evidence-based guideline. The mean cost for a 1-month supply of a typical starting dose was $178. CONCLUSIONS: Sample closet medications have limited novelty and usefulness and are often expensive. The widespread use of sample medications should be reexamined.

Many sample closet medications are expired.

INTRODUCTION: Samples are widely used in office practice. It is not known how many sample medications are expired and therefore not useful to patients. METHODS: We inventoried 10 sample closets in primary care offices to quantify the number of expired medications. RESULTS: Of the 12,581 drug packages and boxes we inventoried in 10 sample closets, 14% of medications were expired. Sample closets varied widely in their organization; the range of expired medications in the 10 closets was 0% to 28%. CONCLUSION: Many sample closet medications are expired, indicating a substantial amount of waste.