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Background: Afflicting 1-2% of the adult population, heart failure (HF) is a condition with considerable morbidity and mortality. While echocardiography may be considered the gold standard diagnostic test, GPs have relied on symptoms and clinical findings in diagnosing the condition.

ObjectivesThe objective of this study was to investigate the use of, and predictors for, pharmaceutical anticancer treatment (PACT) towards the end of a patient’s life in a country with a public healthcare system.DesignRetrospective registry study.SettingSecondary care in Norway.ParticipantsAll Norwegian patients with cancer (International Classification of Diseases tenth revision (ICD-10) codes C00–99, D00–09, D37–48) in contact with a somatic hospital in Norway between 2009 and 2017 (N=420 655). Analyses were performed on a subsample of decedents with follow-back time of more than 1 year (2013–2017, N=52 496).InterventionsN/A.Primary and secondary outcome measuresProportion of patients receiving PACT during the last year and month of life. We calculated CIs with block bootstrapping, while predictors of PACT were estimated with logistic regression.Results24.0% (95% CI 23.4% to 24.6%) of the patients received PACT during the last year of life and 3.2% (95% CI 3.0% to 3.5%) during their final month. The proportion during the last month was highest for multiple myeloma (12.7%) and breast cancer (6.5%) and lowest for urinary tract (1.1%) and prostate and kidney cancer (1.4%). Patients living in northern (OR 0.80, 95% CI 0.68 to 0.94) and western (OR 0.85, 95% CI 0.75 to 0.96) Norway had lower odds of PACT during the last month, while patients with myeloma (OR 3.0, 95% CI 2.5 to 3.7) and breast (OR 1.4, 95% CI 1.1 to 1.6) had higher odds. Kidney cancer (OR 0.25, 95% CI 0.2. to 0.4), urinary tract (OR 0.38, 95% CI 0.3 to 0.5) and prostate cancer (OR 0.4, 95% CI 0.3 to 0.5) were associated with lower probability of receiving PACT within the last month.ConclusionsThe proportion of patients receiving PACT in Norway is lower than in several other industrialised countries. Age, type of cancer and area of living are significant determinants of variation in PACT.

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Aims In clinical practice many patients do not reach the recommended treatment targets for LDL-cholesterol levels. We aimed to examine treatment patterns and adherence for patients on lipid lowering drugs in Norway to inform future strategies to improve therapies. Methods and results We obtained information on all dispensed statins, ezetimibe and PCSK9 inhibitors 2010-2019 from the Norwegian Prescription Database. Treatment gaps were assessed assuming patients take one tablet per day and was defined to occur if a patient did not refill a prescription when the previous one should have been depleted. Treatment was defined as discontinued when the preceding prescription would have been used and no new subsequent prescription was filled. The mean proportion of days covered (PDC) was calculated by aggregating the total number of tablets dispensed during each calendar year and dividing by 365. Patients >80 years were excluded. A considerable proportion of statin users in Norway had long treatment gaps or discontinuation in treatment. 19.6% of the patients had treatment gaps of 180 days or more, and 10.8% had gaps or greater than 365 days. Similar results were found for patients on antidiabetics and hypertensives. PDC ranged from 84.9% for simvastatin to 72.2% for ezetimibe (2019). The most common lipid lowering drugs in 2019 were atorvastatin, simvastatin and ezetimibe. Conclusion There is a great potential for improving drug adherence and optimizing lipid lowering therapy by switching to more effective statins in greater doses, and more Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation often add ezetimibe and PCSK9 inhibitors to treatment.