Effect of continuation of antiplatelet therapy on survival in patients receiving physician home visits.

BACKGROUND: Little is known about the effects of continued antiplatelet therapy in patients who receive physician home visits. This study aimed to evaluate the association of survival with the continuation of antiplatelet drugs in patients who received physician home visits. METHODS: A retrospective cohort study was conducted in a teaching hospital in Toyota, Japan, from April 2015 to October 2018. All patients who received home visits by physicians from the department of Family Medicine of the hospital were included. The primary outcome was the difference in all-cause mortality between patients who were taking antiplatelet drugs and those who were not. The Cox proportional hazards model was applied, adjusted for the patient's demographic features, activities of daily living, comorbidities, and primary disease requiring home care. RESULTS: A total of 815 patients were included, of whom 61 received antiplatelet drugs (n = 42 for aspirin, n = 17 for clopidogrel, and n = 8 for cilostazol) and 772 received no antiplatelet drugs. The mean age of the patients was 78.3 years, 409 (49.1%) were male, and 314 (37.7%) had end-stage cancer. During a median follow-up period of 120 days (interquartile range, 29-364), 54.3% of the patients died. Compared with patients not taking antiplatelet drugs, patients taking antiplatelet drugs had a better outcome (p <  0.01, log-rank test) and a significantly lower hazard ratio (0.34; 95% confidence interval, 0.17-0.65; Cox proportional hazards regression). CONCLUSIONS: The continuous prescription of antiplatelet drugs may have beneficial effects on mortality among patients who receive physician home visits.

Repeated measures of extremely high levels of high-density lipoprotein cholesterol and subsequent all-cause mortality and cardiovascular events: A longitudinal study.

BACKGROUND AND AIMS: Extremely high level high-density lipoprotein (HDL) cholesterol had been cautioned as risk factor for all-cause mortality and cardiovascular disease. However, both the physician and the patient may underestimate the risk due to the emphasis on "good cholesterol", resulting in passive treatment or adoption of a less healthy lifestyle. The aim of this study is to re-evaluate the association with longitudinal data to account for fluctuations in HDL cholesterol and covariates. METHODS: We conducted a retrospective longitudinal study at a large teaching hospital in Tokyo, Japan, from 2005 to 2016. We included all adults who participated in health check-ups. Outcomes were all-cause mortality and cardiovascular events. HDL cholesterol was repeatedly measured at each visit and categorized into five groups. The time-varying Cox model was applied to longitudinal analyses. RESULTS: We included a total of 83,100 participants; the mean age was 45.5 (standard deviation:12.4) years; 41,013 (49.4%) were male, and 4475 participants belonged to the extremely high level HDL cholesterol group (>90 mg/dl). During a median follow-up of 1746 (interquartile range:740-3112.5) days, 382 (0.5%) participants died, and 2023 (2.4%) experienced cardiovascular events. Although the extremely high level HDL cholesterol group had significantly lower hazard ratios (HRs) for all-cause mortality (HR:0.49, 95%confidence interval(CI):0.26-0.90) and cardiovascular events (HR:0.71, 95%CI:0.54-0.94) compared to the low group (<40 mg/dl), HRs were higher than in the very high level HDL cholesterol group. CONCLUSIONS: Our study demonstrated that extremely high level HDL cholesterol has significantly lower risks of all-cause mortality and cardiovascular events compared to low level, but higher risks compared to very high level, as previously reported.

[The role of a multidisciplinary approach in geriatric care and rehabilitation from the acute to the chronic stage].

A multidisciplinary team for bed sores consisted of 10 members including 3 dermatologists, 3 nurses, 1 physical therapist (PT), 1 pharmacist, 1 dietician, and 1 medical clerk. The incidence of new bed sores after admission was significantly decreased from 3.31% in 2003 to 1.04% in 2005 (P < 0.01). A total of 324 percutaneous endoscopic gastrostomy (PEG) procedures were performed from 2001 to January 2006. Among those, the survival of 172 elderly patient (aged 65 years or older at the time of PEG) was calculated by the Kaplan-Meier method. The 30-day mortality rates was 11%, and the 1-year, and 5-year survival rates were 61.2%, and 34.4% respectively. After discharge, 40 patients were followed up at the PEG clinic in our hospital whose staff consisted of 1 expert surgeon, 5 nurses and 1 dietician. When compared with 67 patients transferred to other hospitals or nursing homes, the patients in the PEG clinic showed a significantly longer survival (P < 0.01, 44 versus 29 months). A full-time integrated treatment (FIT) program for stroke rehabilitation was developed in the Nanakuri-Sanatorium of our university in 2000. Eighty-one stroke patients were on the FIT program during their hospital stay and achieved significantly higher activities of daily living (ADL) scores (P < 0.01) at discharge assessed by functional independence measure (FIM) compared to 41 patients on previous rehabilitation program. In addition, their ADL scores were maintained significantly higher (P < 0.05) even at 18 month after discharge, which might help them to stay home independently or with less care burden. These results suggest the important role of multidisciplinary approach for geriatric care and rehabilitation.