Antithrombotic and Lipid Lowering Therapy is Associated With Improved Survival After Vascular Surgery: A Population Based Study From Norway.

OBJECTIVE: This population based retrospective cohort study aimed to investigate the association between combined treatment with lipid lowering drugs and antiplatelet or anticoagulation therapy and long term survival following vascular surgery in Norway. METHODS: The study included all patients who were registered for the treatment of carotid stenosis, abdominal aortic aneurysm (AAA), and atherosclerotic lower extremity arterial disease (LEAD) in the Norwegian Registry for Vascular Surgery between 2015 and 2019 and who were discharged alive. Clinical and medication details were retrieved from the register. Survival was assessed with Kaplan-Meier analysis and a multivariable Cox regression model. Stratification was according to treatment group, patient sex, and if patients received the recommended medications or not. Recommended medications were defined as lipid lowering drugs, usually statins, and antiplatelets, or sometimes anticoagulants, when comorbidity indicated anticoagulation therapy. RESULTS: In total, 15 810 patients had LEAD, 4 080 patients AAA, and 2 194 patients had carotid stenosis. In all treatment groups, survival was superior for patients who used the recommended medications upon discharge. The difference was greatest in patients with LEAD with mean survival periods of 4.33 (95% CI 4.29 - 4.36) and 3.7 (95% CI 3.64 - 3.77) years in patients discharged with and without the recommended medications, respectively (p < .001). The mean survival periods were 4.67 (95% CI 4.61 - 4.73) and 4.34 (95% CI 4.24 - 4.44) years in patients with AAA discharged with and without the recommended medications, respectively (p < .001). Cox regression analysis showed a statistically significantly lower mortality rate for patients discharged with the recommended medications for LEAD (HR 0.58; p < .001) and AAA (HR 0.57; p < .001). CONCLUSION: The recommended medications were associated with improved survival in all treatment groups and both sexes. The survival difference was statistically significant in patients with LEAD and AAA. Patients with LEAD had the greatest improvement; therefore, the recommended secondary prophylaxis is especially important in these patients.

Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial.

BACKGROUND: Most patients with hip fractures are characterised by older age (>70 years), frailty, and functional deterioration, and their long-term outcomes are poor with increased costs. We compared the effectiveness and cost-effectiveness of giving these patients comprehensive geriatric care in a dedicated geriatric ward versus the usual orthopaedic care. METHODS: We did a prospective, single-centre, randomised, parallel-group, controlled trial. Between April 18, 2008, and Dec 30, 2010, we randomly assigned home-dwelling patients with hip-fractures aged 70 years or older who were able to walk 10 m before their fracture, to either comprehensive geriatric care or orthopaedic care in the emergency department, to achieve the required sample of 400 patients. Randomisation was achieved via a web-based, computer-generated, block method with unknown block sizes. The primary outcome, analysed by intention to treat, was mobility measured with the Short Physical Performance Battery (SPPB) 4 months after surgery for the fracture. The type of treatment was not concealed from the patients or staff delivering the care, and assessors were only partly masked to the treatment during follow-up. This trial is registered with ClinicalTrials.gov, number NCT00667914. FINDINGS: We assessed 1077 patients for eligibility, and excluded 680, mainly for not meeting the inclusion criteria such as living in a nursing home or being aged less than 70 years. Of the remaining patients, we randomly assigned 198 to comprehensive geriatric care and 199 to orthopaedic care. At 4 months, 174 patients remained in the comprehensive geriatric care group and 170 in the orthopaedic care group; the main reason for dropout was death. Mean SPPB scores at 4 months were 5·12 (SE 0·20) for comprehensive geriatric care and 4·38 (SE 0·20) for orthopaedic care (between-group difference 0·74, 95% CI 0·18-1·30, p=0·010). INTERPRETATION: Immediate admission of patients aged 70 years or more with a hip fracture to comprehensive geriatric care in a dedicated ward improved mobility at 4 months, compared with the usual orthopaedic care. The results suggest that the treatment of older patients with hip fractures should be organised as orthogeriatric care. FUNDING: Norwegian Research Council, Central Norway Regional Health Authority, St Olav Hospital Trust and Fund for Research and Innovation, Liaison Committee between Central Norway Regional Health Authority and the Norwegian University of Science and Technology, the Department of Neuroscience at the Norwegian University of Science and Technology, Foundation for Scientific and Industrial Research at the Norwegian Institute of Technology (SINTEF), and the Municipality of Trondheim.

Validation and comparison of the health-related quality-of-life instruments EORTC QLQ-C30 and SF-36 in assessment of patients with chronic nonmalignant pain.

The EORTC QLQ-C30 health-related quality of life (HRQoL) questionnaire was developed for use in clinical cancer trials. It has also been applied in studies of patients with chronic nonmalignant pain in spite of nondocumented validity. Validation of the EORTC QLQ-C30 in this patient population and comparison with the traditional first choice HRQoL instrument in chronic nonmalignant pain, the SF-36, are, therefore, required. Two hundred eighty-six patients admitted to the tertiary multidisciplinary pain center at St. Olavs University Hospital in Trondheim, Norway, completed both the EORTC QLQ-C30 and the SF-36 at admittance. Correlations between EORTC QLQ-C30 and SF-36 measures of the same concept were between 0.70 and 0.81 for all five domains covered by both instruments. Internal consistency was below 0.70 for the EORTC QLQ-C30 scales physical functioning (0.57), pain (0.68), role functioning (0.43), cognitive functioning (0.66), and nausea/vomiting (0.53), as well as the SF-36 scale role emotional functioning (0.66). Large floor or ceiling effects were seen for several EORTC QLQ-C30 scales. While SF-36 addresses no other symptoms than pain and fatigue, the EORTC QLQ-C30 also includes sleep, financial difficulties, nausea/vomiting, dyspnea, appetite loss, constipation, and diarrhea. Even though some EORTC QLQ-C30 scales have unsatisfactory internal consistency, EORTC QLQ-C30, similar to SF-36, has overall acceptable psychometric properties. The EORTC QLQ-C30 is a valid alternative to the SF-36 when a broader assessment of symptoms is desired.

Acute geriatric intervention increases the number of patients able to live at home. A prospective randomized study.

BACKGROUND AND AIMS: In a previous publication, we showed that treatment of acutely sick, frail elderly patients in a Geriatric Evaluation and Management Unit (GEMU) reduced mortality considerably when compared with the general Medical Wards (MW). The aim of this presentation was to study the impact of treatment in a GEMU on health care utilization. METHODS: Acutely sick, frail patients, 75 years or older, who had been admitted as emergencies to the Department of Internal Medicine were randomized either to treatment in the GEMU (n=127) or to continued treatment in the MW (n=127). While usual treatment was given in the MW, the GEMU emphasized interdisciplinary and comprehensive assessment of all relevant disorders, early mobilization/rehabilitation, and discharge planning. After discharge from hospital, no specific follow-up was offered to any of the groups. RESULTS: Of all subjects, 101 (80%) GEMU and 79 (64%) MW patients were still living in their own homes at three months (p=0.005); at six months the number was 91 (72%) and 74 (60%) (p=0.04) respectively. Median length of index stay was 19 days in the GEMU and 13 days in the MW group (p<0.001). After the initial stay, there were no statistically significant differences in admissions to or time spent in institutions. CONCLUSIONS: The results indicate the overall positive treatment effect of acutely sick, frail elderly in a GEMU, i.e. patients treated in the GEMU had increased possibilities of living in their own homes, an effect that was mainly related to considerably reduced mortality in the GEMU group.