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1.
J Assoc Physicians India ; 69(4): 11-12, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34470187

RESUMO

OBJECTIVE: Guidelines recommend prescription of statins in all high-risk patients with hypertension irrespective of their cholesterol levels. We performed a prescription audit in India to determine the application of recommendations. METHODS: A registry-based audit of patients with primary diagnosis of hypertension (n=3073) was performed. Details of co-morbidities and medications were obtained. Patients with known vascular disease were excluded. Patients were classified into subgroups based on risk factors and type of therapy. A multivariate model of risk was developed using clinical data and patients were classified into low, moderate and high risk. Statin prescriptions were divided into low, medium and high intensity based on US guidelines. Descriptive statistics are reported. RESULTS: Mean age of patients was 59±13 years, 47 % were women and 26 % were less than 50 years age. Diabetes was noted in 31.1 %, current smoking in 1.3 %, obesity in 14.7 % and hypothyroidism in 7.9 %. Statins were prescribed in 41.2 % (95% CI 39.4-42.9%), more in men compared to women (47.7% vs 33.7%, p<0.001). Most of the patients received moderate intensity statins (83.9%). In age-groups >40, 40-59, 60-79 and 80+ years, statins were prescribed in 18.7%, 36.5%, 49.5% and 49.4% respectively (ptrend <0.001). Statins were prescribed in 52.0% diabetics, 60.9% obese, 52.5% smokers and 34.8% hypothyroid. In the multivariate model statins use in low, medium and high risk patients was 28.4%, 46.6% and 55.1% respectively (ptrend <0.001). CONCLUSION: In an Indian secondary care practice only half of patients with moderate to high risk uncomplicated hypertension receive statins.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Hipertensão , Adulto , Idoso , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prescrições , Fatores de Risco
2.
Indian Heart J ; 68(6): 832-840, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27931556

RESUMO

OBJECTIVE: To evaluate usefulness of non-physician health workers (NPHW) to improve adherence to medications and lifestyles following acute coronary syndrome (ACS). METHODS: We randomized 100 patients at hospital discharge following ACS to NPHW intervention (n=50) or standard care (n=50) in an open label study. NPHW was trained for interventions to improve adherence to medicines - antiplatelets, ß-blockers, renin-angiotensin system (RAS) blockers and statins and healthy lifestyles. Intervention lasted 12 months with passive follow-up for another 12. Both groups were assessed for adherence using a standardized questionnaire. RESULTS: ST elevation myocardial infarction (STEMI) was in 49 and non-STEMI in 51, mean age was 59.0±11 years. 57% STEMI were thrombolyzed. On admission majority were physically inactive (71%), consumed unhealthy diets (high fat 77%, high salt 58%, low fiber 57%) and 21% were smokers/tobacco users. Coronary revascularization was performed in 90% (percutaneous intervention 79%, bypass surgery 11%). Drugs at discharge were antiplatelets 100%, ß-blockers 71%, RAS blockers 71% and statins 99%. Intervention and control groups had similar characteristics. At 12 and 24 months, respectively, in intervention vs control groups adherence (>80%) was: anti platelets 92.0% vs 77.1% and 83.3% vs 40.9%, ß blockers 97.2% vs 90.3% and 84.8% vs 45.0%), RAS blockers 95.1% vs 82.3% and 89.5% vs 46.1%, and statins 94.0% vs 70.8% and 87.5% vs 29.5%; smoking rates were 0.0% vs 12.5% and 4.2% vs 20.5%, regular physical activity 96.0% vs 50.0%, and 37.5% vs 34.1%, and healthy diet score 5.0 vs 3.0, and 4.0 vs 2.0 (p<0.01 for all). Intervention vs standard group at 12 months had significantly lower mean systolic BP, heart rate, body mass index, waist:hip ratio, total cholesterol, triglyceride, and LDL cholesterol (p<0.01). CONCLUSIONS: NPHW-led educational intervention for 12 months improved adherence to evidence based medicines and healthy lifestyles. Efficacy continued for 24 months with attrition.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Agentes Comunitários de Saúde , Estilo de Vida Saudável , Adesão à Medicação/estatística & dados numéricos , Prevenção Secundária/métodos , Síndrome Coronariana Aguda/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
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