Systematic Review of Glucagon-Like Peptide One Receptor Agonist Liraglutide of Subjects with Heart Failure with Reduced Left Ventricular Ejection Fraction.

BACKGROUND: The major cardiovascular outcome trials on glucagon-like peptide one-receptor agonists have examined its effect on hospitalization of subjects with heart failure; however, very limited trials have been conducted on subjects with reduced left ventricular ejection fraction (r- LVEF) as a primary outcome. OBJECTIVE: We have conducted a systematic review of two major (FIGHT and LIVE) placebo-controlled trials of liraglutide and its clinical effect on the ejection fraction of subjects with heart failure. METHODS: Medline data was retrieved for trials involving liraglutide from 2012 to 2020. The inclusion criteria for trials were: subjects with or without type 2 diabetes mellitus (T2DM), subjects with heart failure with rLVEF, major trials (phase II or III) on liraglutide, trials included liraglutide with defined efficacy primary outcome of patients with heart failure with rLVEF. The search was limited to the English language, whereby two trials [FIGHT and LIVE] had been included and two trials were excluded due to different primary outcomes. Participants (541) had been randomized for either liraglutide or placebo for 24 weeks. RESULTS: In the FIGHT trial the primary intention-to-treat, sensitivity, and diabetes subgroup analyses have shown no significant between-group difference in the global rank scores (mean rank of 146 in the liraglutide group versus 156 in the placebo group; Wilcoxon rank-sum P=.31), number of deaths, re-hospitalizations for heart failure, or the composite of death or change in NT-pro BNP level (P= .94). In the LIVE trial, the change in the left ventricular ejection fraction (LVEF) from baseline to week 24 was not significantly different between treatment groups. The overall discontinuation rate of liraglutide was high in the FIGHT trial (29%, 86) as compared to that in the LIVE trial (11.6%, 28). CONCLUSION: FIGHT and LIVE trials have demonstrated that liraglutide use in subjects with heart failure and rLVEF was implicated with an increased adverse risk of heart failure-related outcomes.

Patients' Satisfaction with Primary Health Care Centers' Services, Majmaah, Kingdom of Saudi of Saudi Arabia.

BACKGROUND: PHC Patient' satisfaction represents a key marker for the quality of health care delivery and this internationally accepted factor needs to be studied repeatedly for smooth functioning of the health care systems. The objectives of the current study were to determine the level of patients' satisfaction with the primary health care services provided in Majmaah city, Kingdom of Saudi Arabia; to identify the reasons behind satisfaction or dissatisfaction and to determine the effect of the social factors on the level of satisfaction. METHODOLOGY: The study was a cross-sectional facility- based. The sample comprised 370 patients selected by stratified and systematic sampling at the health centers' level and the patients' level respectively. The data were collected by a pre-tested questionnaire and analyzed by SPSS software. RESULTS: Patients' level of satisfaction was 82%. The reasons behind satisfaction were cleanliness of the facilities and technical competencies of the staff (33.1% and 24.2%). The study showed that the most stated reason behind dissatisfaction was the unsuitable buildings (29%). Significant association was found between the level of patients' satisfaction about PHC centers services and the respondents' level of education. CONCLUSION: The level of satisfaction with the services provided by PHC centers in Majmaah is high. The gender, marital status and income have no effect on the level of satisfaction with the services provided by PHC centers. However, the lower educated are more satisfied than the higher educated. Cleanliness, competence of the staff along with respect and good handling are the drivers behind the high level of satisfaction.