Peripheral arterial disease is a chronic vascular disease characterized by impaired circulation to the lower extremities. Its most severe stage, known as critical limb ischemia (CLI), puts patients at an increased risk of cardiovascular events, amputation, and death. The objective of this literature review is to describe the burden of disease across a comprehensive set of domains—epidemiologic, clinical, humanistic, and economic—focusing on key studies published in the last decade. CLI prevalence in the United States is estimated to be approximately 2 million and is likely to rise in the coming years given trends in important risk factors such as age, diabetes, and smoking. Hospitalization for CLI patients is common and up to 60% are readmitted within 6 months. Amputation rates are unacceptably high with a disproportionate risk for certain demographic and socioeconomic groups. In addition to limb loss, CLI patients also have reduced life expectancy with mortality typically exceeding 50% by 5 years. Given the poor clinical prognosis, it is unsurprising that the quality of life burden associated with CLI is significant. Studies assessing quality of life in CLI patients have used a variety of generic and disease-specific measures and all document a substantial impact of the disease on the patient’s physical, social, and emotional health status compared to population norms. Finally, the poor clinical outcomes and increased medical resource use lead to a considerable economic burden for national health care systems. However, published cost studies are not comprehensive and, therefore, likely underestimate the true economic impact of CLI. Our summary documents a sobering assessment of CLI burden—a poor clinical prognosis translating into diminished quality of life and high costs for millions of patients. Continued prevention efforts and improved treatment strategies are the key to ameliorating the substantial morbidity and mortality associated with this disease.
Aim: This study compared real-world complication rates, hospitalization duration and costs, among patients undergoing arterial repair using the Perclose ProGlide (ProGlide) versus surgical cutdown (Cutdown). Materials & methods: Retrospective study of matched patients who underwent transcatheter aortic valve replacement/repair, endovascular abdominal aortic aneurysm repair, thoracic endovascular aortic repair or balloon aortic valvuloplasty with arterial repair by either ProGlide or Cutdown between 1 January 2013 and 24 April 2017. Results: Infections and blood transfusions were lower in the ProGlide cohort. Patients in the ProGlide cohort had a 42.5% shorter index hospitalization, which corresponded to US$14,687 lower costs. Conclusion: The use of ProGlide for arterial repair was associated with significantly lower transfusion rates, shorter index hospitalization and lower hospitalization costs compared with surgical cutdown.
Little is known regarding consumption of over-the-counter (OTC) medications by the blind. They may face difficulty while accessing information from OTC medication labels. This exploratory, cross-sectional study was designed to determine blind consumers' attitude and purchase behavior towards OTC medications and use of low-vision tools while using these medications.
OBJECTIVES: Following a FDA warning in November 2009, significant controversy exists regarding the outcomes of patients co-medicated with clopidogrel and omeprazole after acute coronary syndrome (ACS). This study examined the effect of proton pump inhibitors (PPI) -clopidogrel interactions on subsequent ACS emergency department and inpatient visits. METHODS: This was a retrospective cohort study of administrative claims data for a large nationally dispersed group of commercially insured subjects between 2001 and 2008. Subjects age Ͼ18 years with a diagnosis of ACS and at least one clopidogrel prescription within 90 days after the diagnosis were included. The clopidogrel plus PPI (CϩPPI) group was defined as subjects with a minimum of 7 days overlap between the PPI and clopidogrel prescriptions. Subjects were followed from their first clopidogrel prescription until they experienced a re-hospitalization or ER visit due to ACS, disenrolled or reached the study end. CϩPPI group was matched 1:1 with clopidogrel group using propensity scoring methods with calipers. Cox proportional hazards regression was used to estimate the relative risk of an adverse cardiovascular event. RESULTS: Of the 10,101 patients taking clopidogrel, 16.98% (nϭ1,716) were prescribed a PPI. Propensity matching resulted in 1,697 patient pairs. The mean age was 61.50 years with a mean follow up of 259 days and 69.64% were males. 13.20% (nϭ224) had an ACSrelated re-hospitalization or ER visit in the clopidogrel group versus 16.32% (nϭ277) in the CϩPPI group. CϩPPI use was not associated with a significantly increased risk of adverse outcomes (HRϭ1.221; 95% CI, 0.984-1.517) compared to clopidogrel users not co-medicated with a PPI. CONCLUSIONS: Concurrent use of clopidogrel and PPIs trended toward a non-significant increase in risk of adverse cardiovascular outcomes for ACS patients, which suggests caution may be warranted when prescribing a PPI with clopidogrel. Future studies should account for time dependence of exposure.OBJECTIVES: Many agents used in treating AF have potential gastrointestinal (GI) tolerability issues. Treatment-related adverse GI events are a common reason for noncompliance to treatment. The current analysis describes the prevalence of dyspepsia in relation to anticoagulant use among AF patients. METHODS: Data were obtained from the 2009 National Health and Wellness Survey (Nϭ75,000), an annual cross-sectional Internet-based survey of US adults. Respondents answered general demographic and health-related questions. A CHADS 2 score (an index of stroke risk) was calculated for each patient using demographic and clinical characteristics. RESULTS: A total of 1297 patients (1.7%) reported a diagnosis of AF. Of these patients, 535 (41%) also reported a physician-diagnosed GI condition; 449 of these (84%) were consistent with dyspepsia (ulcers, abdominal bloating, abdominal pain, gastroesophageal reflux disease/acid reflux, or heartburn). Compared with AF patients without dyspepsia (nϭ848), those with dyspepsia were younger (mean 62....
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.