Patients with anemia and patients with chronic kidney disease have elevated risks for cardiovascular disease. Available studies have been too small to provide details about the relationship or to provide for extensive covariate control. In a large insurance database with linked laboratory values, records of women with serum creatinine >1.2 mg/dl and men with serum creatinine >1.4 mg/dl, identified from July 2000 through June 2003, were sought, and the insurance claims searches for hospitalizations that were associated with myocardial infarction, coronary revascularization, unstable angina, stroke, or congestive heart failure. New onset of dialysis also was sought. Multivariate Poisson regression was used to estimate rate ratios for these events at various hemoglobin (Hb) levels, with adjustment for patient characteristics and previous event history. Among 88,657 patients with high serum creatinine, the risk for hospitalization with myocardial infarction was two to five times higher in anemic (Hb <12 g/dl) patients than in people with Hb from 12.0 to 12.9 g/dl. A similar but less dramatic pattern of higher incidence of coronary revascularization was observed with lower Hb levels. Risks for hospitalization with congestive heart failure declined regularly with increasing Hb levels from a doubling of risk at Hb <10 g/dl to a 61% decrease at 15 g/dl, both relative to 12.0 to 12.9 g/dl. The risk for progression to dialysis was only slightly elevated (7 to 34%) in anemic patients. Anemia raises the risk for cardiovascular disease in patients with elevated serum creatinine.
Rates of abdominopelvic surgery, with a particular focus on gallbladder procedures, were measured in patients with irritable bowel syndrome (IBS) (n = 108,936) and compared with those in a general population sample (n = 223,082). The patient sample was selected from persons who were members of a managed care organization during the years 1995-2000. Medical records from a randomly selected subset of IBS patients were reviewed to confirm the diagnosis. Crude and standardized rates and adjusted rate ratios for surgery were calculated. The incidence of abdominopelvic surgery, excluding gallbladder procedures, was 87% higher in patients with IBS than that for the general population. The incidence of gallbladder surgery was threefold higher in IBS patients than the general population. Patients with IBS have an increased risk for abdominopelvic and gallbladder surgery and, thus, an associated risk for experiencing morbidity and mortality associated with these surgical procedures.
The COACH patient-support program was launched in 2015 to support and educate patients prescribed insulin glargine 300 U/mL (Gla-300). The study objective was to assess program impact on adherence and persistence among patients with T2D on Gla-300 therapy. A retrospective cohort study was conducted, linking data from COACH to patient data in the IQVIA Integrated Data Warehouse. Overall inclusion criteria for patients identified from 2/1/2016-7/31/2016 were: ≥1 T2D diagnosis code, aged ≥18 years, ≥1 pharmacy claim for Gla-300 (first claim as index date), continuous database activity for ≥180 days preceding the 6-month pre-index, and pharmacy stability in the 6-month pre-index. Exclusion criteria were: ≥1 pharmacy claim for another basal insulin ≤14 days preceding index, and data-quality issues. Patients from the COACH Participant cohort (active participants of the program) were directly matched to a Non-COACH cohort of patients not enrolled in COACH. Patients who were insulin naive, switched from any other basal insulin to Gla-300, and with high levels of engagement to COACH were analyzed as subcohorts. Treatment persistence and adherence were measured over a 12-month follow-up. The matched cohorts included 544 patients each. Over 12 months, a significantly greater proportion of COACH Participants were persistent (48.5% vs. 42.1%; p=0.0309) and adherent (68.0% vs. 61.4%; p=0.0201) to Gla-300 compared with patients in the Non-COACH cohort. In multivariate adjusted analyses, the odds of being adherent to index medication were 1.81 times higher (OR 1.81; p=0.0002) and the risk of discontinuation was 40% lower (HR 0.60; p<0.0001) for COACH Participants. Similar results were found among naive and switching subcohorts. A higher level of engagement with COACH was associated with a lower risk of discontinuation. Active participation in the COACH patient-support program was associated with improved adherence and persistence to Gla-300. Disclosure F.L. Zhou: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. Employee; Spouse/Partner; Lexicon Pharmaceuticals, Inc.. Stock/Shareholder; Spouse/Partner; Lexicon Pharmaceuticals, Inc. J. Yeaw: Other Relationship; Self; Sanofi US. S. Karkare: None. M. DeKoven: None. T.S. Reid: Speaker's Bureau; Self; Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Sanofi. Advisory Panel; Self; Sanofi, Janssen Pharmaceuticals, Inc.. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc.. Consultant; Self; AstraZeneca, Intarcia Therapeutics, Inc.. Speaker's Bureau; Self; Lilly.
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