A real-world analysis of outcomes and healthcare costs of patients on perindopril/indapamide/amlodipine single-pill vs. multiple-pill combination in Italy.

OBJECTIVES: This analysis compared adherence, cardiovascular (CV) events and all-cause mortality incidence, and healthcare costs among hypertensive patients treated with perindopril (PER)/indapamide (IND)/amlodipine (AML) in single-pill combination (SPC) vs. multiple-pill combination, in a real-world setting in Italy. METHODS: In this observational retrospective analysis of Italian administrative databases, adult patients treated with PER/IND/AML between 2010 and 2020 were divided into two cohorts: single-pill vs. multiple-pill. Patient data were available for at least one year before and after index date. Propensity score matching (PSM) was applied to reduce selection bias. Adherence was defined as proportion of days covered: non-adherence, <40%; partial adherence, 40-79%, and adherence ≥80%. Mortality incidence and CV events as single, or composite, endpoints were evaluated after first year of follow-up. Healthcare cost analyses were performed from the perspective of the Italian National Health Service. RESULTS: Following PSM, the single-pill cohort included 12 150 patients, and the multiple-pill cohort, 6105. The SPC cohort had a significantly higher percentage of adherent patients vs. the multiple-pill cohort (59.9% vs. 26.9%, P  < 0.001). Following the first year of follow-up, incidence of all-cause mortality, and combined endpoint of all-cause mortality and CV events were lower in the SPC cohort compared with multiple-pill cohort. Average annual direct healthcare costs were lower in the single-pill cohort (€2970) vs. multiple-pill cohort (€3642); cost of all drugs and all-cause hospitalizations were major contributors. CONCLUSION: The SPC of PER/IND/AML, compared with multiple-pill combination, is associated with higher adherence to medication, lower incidence of CV events and mortality, and reduced healthcare costs.

Coronary Artery Disease Assessment and Cardiovascular Events in Middle-Aged Patients on Hemodialysis.

OBJECTIVE: To explore whether, in younger patients on dialysis with longer life expectancy, assessment of coronary artery disease (CAD) could identify individuals at higher risk of events and revascularization might improve outcomes in selected patients contrary to what had been observed in elderly patients. METHODS: From August 1997 to January 2019, 2265 patients with stage 5 chronic kidney disease were prospectively referred for cardiovascular assessment. For this study, we selected 1374 asymptomatic patients aged between 18 and 64 years. After clinical risk stratification and cardiac scintigraphy by single-photon emission computed tomography, 866 patients underwent coronary angiography. The primary end point was the composite incidence of nonfatal/fatal major adverse cardiovascular events during a follow-up period of 0.1 to 189.7 months (median, 26 months). The secondary end point was all-cause mortality. RESULTS: The primary end point occurred in 327 (23.8%) patients. Clinically stratified high-risk patients had a 3-fold increased risk of the primary end point. The prevalence of abnormal findings on perfusion scans was 29.2% (n=375), and significant CAD was found in 449 (51.8%) of 866 patients who underwent coronary angiography. An abnormal finding on myocardial perfusion scan and the presence of CAD were significantly associated with a 74% and 22% increased risk of cardiovascular events, respectively. In patients undergoing percutaneous coronary intervention or coronary artery bypass grafting (n=99), there was an 18% reduction in the risk of all-cause death relative to patients receiving medical treatment (P=.03). CONCLUSION: In this cohort of middle-aged, asymptomatic patients on dialysis, assessment of CAD identified individuals at higher risk of events, and coronary intervention was associated with reducing the risk of death in selected patients.

Population health impact and economic evaluation of the CARDIO4Cities approach to improve urban hypertension management.

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with 80% of that mortality occurring in low- and middle-income countries. Hypertension, its primary risk factor, can be effectively addressed through multisectoral, multi-intervention initiatives. However, evidence for the population-level impact on cardiovascular (CV) event rates and mortality, and the cost-effectiveness of such initiatives is scarce as long-term longitudinal data is often lacking. Here, we model the long-term population health impact and cost-effectiveness of a multisectoral urban population health initiative designed to reduce hypertension, conducted in Ulaanbaatar (Mongolia), Dakar (Senegal), and in the district of Itaquera in São Paulo (Brazil) in collaboration with the local governments. We based our analysis on cohort-level data among hypertensive patients on treatment and control rates from a real-world effectiveness study of the CARDIO4Cities approach (built on quality of care, early access, policy reform, data and digital, Intersectoral collaboration, and local ownership). We built a decision tree model to estimate the CV event rates during implementation (1-2 years) and a Markov model to project health outcomes over 10 years. We estimated the number of CV events averted and quality-adjusted life-years gained (QALYs through the initiative and assessed its cost-effectiveness based on the costs reported by the funder using the incremental cost effectiveness ratio (ICER) and published thresholds. A one-way sensitivity analysis was performed to assess the robustness of the results. The modelled patient cohorts included 10,075 patients treated for hypertension in Ulaanbaatar, 5,236 in Dakar, and 5,844 in São Paulo. We estimated that 3.3-12.8% of strokes and 3.0-12.0% of coronary heart disease (CHD) events were averted during 1-2 years of implementation in the three cities. We estimated that over the subsequent 10 years, 3.6-9.9% of strokes, 2.8-7.8% of CHD events, and 2.7-7.9% of premature deaths would be averted. The estimated ICER was USD 748 QALY gained in Ulaanbaatar, USD 3091 in Dakar, and USD 784 in São Paulo. With that, the intervention was estimated to be cost-effective in Ulaanbaatar and São Paulo. For Dakar, cost-effectiveness was met under WHO-CHOICE standards, but not under more conservative standards adjusted for purchasing power parity (PPP) and opportunity costs. The findings were robust to the sensitivity analysis. Our results provide evidence that the favorable impact of multisector systemic interventions designed to reduce the hypertension burden extend to long-term population-level CV health outcomes and are likely cost-effective. The CARDIO4Cities approach is predicted to be a cost-effective solution to alleviate the growing CVD burden in cities across the world.

Qualidade de vida de pacientes em hemodiálise com doença coronariana versus sem doença coronariana / Quality of life of hemodialysis patients with coronary disease versus no coronary disease

A doença renal crônica (DRC) é um problema da saúde pública mundial e preditora para progressão da doença arterial coronariana (DAC), causando limitações e alterações na vida cotidiana dos pacientes e familiares e, consequentemente, na qualidade de vida. Nesse cenário, o Assistente Social, como integrante da equipe multiprofissional, propõe alternativas de enfrentamento às situações que comprometem o processo da saú - de-doença dos pacientes. O estudo tem como objetivos avaliar o impacto da presença da DAC na qualidade de vida dos pacientes em hemodiálise e identificar as diferenças no perfil sociodemográfico desses pacientes, conforme a presença da doença. Método: Estudo trans - versal e descritivo realizado com 51 pacientes em hemodiálise (30 com DAC e 21 sem DAC), em um hospital universitário de cardiologia de São Paulo, através de questionário de qualidade de vida para pacientes em tratamento dialítico KDQOL-SF TM 1.3, questionário socioeconômico e dados clínicos descritos em prontuário eletrônico. Resultados: No to - tal dos pacientes, houve predomínio do sexo masculino, da cor/raça autodeclarada par - da e preta, ensino fundamental incompleto e em benefício previdenciário/assistencial. Os pacientes sem DAC encontram-se aproximadamente dois anos a mais em tratamento dia - lítico. Entre as dimensões do KDQOL-SF TM 1.3, os pacientes com DAC apresentaram melhores índices de qualidade de vida. Conclusão: A qualidade de vida dos pacientes com DRC em hemodiálise que apresentam diagnóstico de DAC, apresentou-se relativamente melhor do que a dos pacientes sem DAC. Não houve diferenças sociodemográficas relevantes entre os grupo

Chronic kidney disease (CKD) is a worldwide public health problem and a predictor of the progression of coronary artery disease (CAD), causing limitations and changes in the daily lives of patients and their families and, therefore, in their quality of life. In this scenario, the Social Worker, as a member of a multiprofessional team, proposes alternatives for coping with situations that compromise patients' health-disease process. The aims of this study were to assess the impact of the presence of CAD on the quality of life of patients on hemodialysis, and to identify the differences in sociodemographic profile of these patients, according to the presence of CAD. Methods: A cross-sectional, descriptive study was conducted with 51 patients on hemodialysis treatment, (30 with CAD and 21 without CAD), at a university cardiology hospital in the city of São Paulo, using a quality of life questionnaire for patients on dialysis treatment KDQOL-SF TM 1.3, a socioeconomic questionnaire, and clinical data described in the electronic medical records. Results: Of the total patients, there was a predominance of males, with self-declared color/race Brown and Black, incomplete primary education, and receiving social security benefits. The patients without CAD had been in dialysis treatment for approximately two years more. Among the dimensions of the KDQOL-SF TM 1.3, patients with CAD had better quality of life indices. Conclusion: The quality of life of patients with CKD on hemodialysis and diagnosed with CAD was relatively better than that of patients without ut CAD. There were no relevant sociodemographic differences between the group

Religiosity Index and Quality of Life in the search for better blood pressure control / Índice de religiosidade e qualidade de vida na busca do melhor controle da pressão arterial

Systemic arterial hypertension (SAH) is a chronic non-communicable disease, and currently the relationships betweenreligiosity, physical and mental health have been investigated. The objective of this study was to verify the associationof the religiosity index through the DUREL scale with the best control of blood pressure (SBP ≤ 120 and DBP ≤ 80) andquality of life in hypertensive patients. A prospective longitudinal study was conducted with 56 hypertensive patients,who were followed up for 120 days and underwent a 20-day interval nursing visit, in which a counseling program wasdeveloped. The instrument for quality of life, the DUREL Religiosity Scale, was applied and Ambulatory Blood PressureMonitor (ABPM) was performed at the beginning and end of the study. The study involved 30 women (55.6%) and26 men (44.4%), mean age of 53.9 ± 10 years, mean BMI of 30.3±5 kg/m2, waist circumference (WC)=99.7±5cm;PAS=153.6±28mmHg; DBP=91.6±17mmHg and Heart Rate (HR)=69±13bpm. Regarding BP control (SBP ≤ 120 andDBP ≤ 80), at the end of 120 days, it was observed that only 4 (7.14%) patients controlled their BP by the clinic’smeasurement and 25 patients by the measurement of the ABPM, those being 7 (12.5%) in the wake period and 18(32.1%) in the sleep period. However, there was no association with the Index of Religiosity and quality of life whencompared to the control variable of blood pressure. Given the data, it was determined that the religiosity index was notsensitive enough to identify patients with a better control of BP after 120 days of follow-up(AU)

A hipertensão arterial sistêmica (HAS) é uma doença crônica não transmissível, atualmente as relações entrereligiosidade, saúde física e mental vem sendo investigadas. O objetivo deste estudo foi verificar a associação doíndice de religiosidade por meio da escala de Durel com o melhor controle da pressão arterial (PAS ≤ 120 e PAD≤ 80) e qualidade de vida em pacientes hipertensos. Utilizou-se estudo prospectivo longitudinal com 56 pacienteshipertensos, que foram acompanhados por 120 dias submetidos à consulta de enfermagem com intervalos de 20 dias,na qual era desenvolvido um programa de orientação. Foi aplicado o instrumento de qualidade de vida, a escala deReligiosidade de Dure e realizada a Monitorizarão Ambulatorial da Pressão Arterial (MAPA) no início do estudo eao final. O estudo envolveu 30 mulheres (55,6%) e 26 homens (44,4%), com idade média de 53,9±10 anos, IMCmédio de 30,3±5 kg/m2, circunferência abdominal (CA)=99,7±5cm; PAS=153,6±28mmHg; PAD =91,6±17mmHge Frequência Cardíaca (FC)=69,±13bpm. Quanto ao controle da PA (PAS ≤ 120 e PAD ≤ 80), ao final de 120 diasobservou-se que apenas 4 (7,14%) pacientes controlaram a PA pela medida de consultório e 25 pacientes pela medidada MAPA sendo 7 (12,5%) no período da vigília e 18 (32,1%) no período do sono. Entretanto não se identificouassociação com o Índice de Religiosidade e qualidade de vida quando comparado com a variável controle da pressãoarterial. Diante dos dados verificou-se que o índice de religiosidade não se mostrou sensível para identificar pacientescom um melhor controle da PA após 120 dias de acompanhamento(AU)