Aim:The objective of this article is to evaluate the relationship between the changes in prescriptions of antiosteoporotic drugs (mainly the rapid fall in the use of bisphosphonates [BPs]) and standardized hip fracture (HF) rates over the period 2005–2008 in the Australian Capital Territory (ACT).Methods:Annual sex- and age-specific HF rates (per 100,000 population) were determined and standardized using the Australian 2006 population census. Data on the annual prescriptions of BPs (mainly alendronate and risedronate), strontium ranelate, and hormone replacement therapy were obtained from the Australian Pharmaceutical Benefits Scheme (PBS) and Repatriation Australian Pharmaceutical Benefits Scheme (RPBS) databases.Results:In the ACT, the peak annual number of prescriptions for BPs was observed in 2006. Following reports linking osteonecrosis of the jaw with BP use, the number of BP prescriptions dropped by 14% in 2007–2008 compared with 2005, when the lowest HF rates were recorded. The reduction in BP prescriptions coincided with increased HF rates in females in 2007 (+22.6%) and in 2008 (+25.2%) compared with 2005; in males, HF incidence declined by 6.6% and 16.7%, respectively. The proportion of filled prescriptions for strontium ranelate, risedronate, and alendronate in 2007–2008 was 1:8.4:15.5, indicating that BPs were the dominant antiosteoporotic drugs. There was an inverse statistically significant relationship between the total annual number of BP prescriptions and standardized HF incidence rates for the 10-year period 1999–2008.Conclusion:Although currently there is no clear understanding of factors contributing to changing HF epidemiology, the available evidence suggests that much of the decline in HF rates is due to the use of BPs. The fall in the use of BPs is associated with an increase in HF rates in females, indicating that BPs should still be considered the first-line medications for the prevention and treatment of osteoporosis. Our results need to be confirmed in other populations and countries.
Our study demonstrates favorable trends in stroke survivor rates in Australia in the first decade of the new millennium and projects in the foreseeable future significant increases in the absolute numbers of older stroke survivors, especially among those aged 70 years or older and men.
Objectives To analyze the main epidemiological, clinical and immunological characteristics and baseline predictors associated with survival in a large cohort of patients with systemic amyloidosis. Methods In May 2013, the Study Group on Autoimmune Diseases (GEAS) of the Spanish Society of Internal Medicine created the national registry of patients with amyloidosis (RAMYD). The classification of amyloidosis was based on the chemical characterization of the precursor protein. The 4 main types of systemic amyloidosis are AL, AA, ATTR, and Aβ2M type/others. Patients with localized deposition of amyloid were excluded. Results A total of 570 patients with amyloidosis were included, 311 men, 259 women (mean age at dx: 64 years, range 19-93). Associated diseases were: hematological diseases 19%, inflammatory rheumatic diseases 10%, systemic autoimmune diseases 8%, non-hematologic neoplasms 6% and chronic infections 6%. We were able to classify amyloidosis in 71% patients: 36% AA amyloidosis, 135% AL, 20% ATTR and 9% others. Vital status was obteined in 478 patients, of which 298 (62%) died. Patients who died had an older mean age at diagnosis (67.29 vs 57.58 years in survivals, p<0.001). A higher mortality rate was observed in patients with associated hematological diseases (23% vs 16%, p=0.043), those with chronic infections (3% vs 8%, p=0.038), and in patients presenting with renal (38% vs 20%, p<0.001), cardiac (29% vs 15%, p=0.002) and pulmonary (16% vs 10%, p=0.048) involvements, while those presenting with peripheral neuropathy (13% vs 29%, p<0.001) and skin involvement (1% vs 7%, p=0.001) showed a low rate of mortality. Global mortality rate was 78% in AL amyloidosis, 66% in AA amyloidosis, 62% in patients who failed to amyloidosis classification, 47% in ATTR amyloidosis and 39% in patients with other types of amyloidosis. Conclusions The rate of mortality of patients diagnosed with systemic amyloidosis exceeds 60% of cases, with AL amyloidosis having the highest mortality rate. The main baseline prognostic factors associated with death were older age, hematological diseases, and involvement of kidneys, lungs, heart. Our results, which demonstrated a global mortality rate of two-thirds of cases, serve to emphasize that the optimal management for systemic amyloidosis remains to be defined. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.5896
Objective: Out-of-hospital cardiac arrest is an event with an extremely poor prognosis. There is limited literature on the outcomes for regional Australia, with none specifically addressing remote populations. We aimed to assess outof-hospital cardiac arrest outcomes in the aeromedical retrieval population of the Top End Medical Retrieval Service. Design:We retrospectively identified all cardiac arrests, deaths and patients who had cardiopulmonary resuscitation within the aeromedical retrieval database for a 5-year period from January 2012 to December 2016. Setting: Retrieval patients across the Top End of the Northern Territory, Australia. Participants: All patients within the cohort with a non-traumatic out-ofhospital cardiac arrest. Main outcome measures: Data were collected on outcomes as per Utstein definitions, along with patient demographics, retrieval timings and interventions.Results: Seventy-five patients suffering cardiac arrest were identified, with 58 having a non-traumatic arrest in an out-of-hospital setting. The median age of the cohort was 40 years, and 53% had an initial shockable rhythm. Return of spontaneous circulation was achieved in 55% and 43% survived to hospital. The survival to hospital discharge and 28 days were 31% and 29%, respectively. Conclusions:Although the study has a small sample size and limitations on generalisability due to the restricted nature of the cohort selection, the results suggest a 28-day survival rate is potentially comparable to other regions of Australia and the rest of the world. Further research needs to be undertaken in out-of-hospital cardiac arrest in remote regions to establish a true populationbased cohort and ascertain where improvements can be made.
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