Average Proportion Of Patients Research Articles

Ezetimibe use and mortality after myocardial infarction: a nationwide cohort study

Abstract Background Inhibition of intestinal cholesterol absorption by ezetimibe improves outcomes after myocardial infarction (MI), yet real-world data on ezetimibe is lacking. Purpose To study usage and outcome impact of ezetimibe after MI. Methods Consecutive MI patients in Finland (2010-2018) were retrospectively studied (N=57,505; 65% men; mean age 69 years). Study data were combined from national registries. The median follow-up was 4.5 (IQR 2.8-7.1) years. Differences between groups were adjusted with multivariable regression. Ezetimibe use was studied with competing risk analyses. Median follow-up was 4.5 (IQR 2.8-7.1) years. Results The cumulative incidence of ezetimibe use was 3.7% at 90-days, 13.4% at 5-years and 19.8% at 10-years. Younger age was the strongest predictor for ezetimibe use (adj. sHR 6.67; CI 5.88-7.69 for patients aged <60 vs. ≥80 years). Women were more likely to use ezetimibe during follow-up than men. The average proportion of patients using ezetimibe during follow-up was 6.8%. (11.7% at 10-years). Ezetimibe was discontinued by 43.6% of patients during the follow-up. Patients with early ezetimibe after MI had lower all-cause mortality during follow-up (33.6% vs. 45.1%; adj. HR 0.77; CI 0.69-0.86; p<0.0001). Early ezetimibe use was associated with lower mortality irrespective of sex, age, atrial fibrillation, diabetes, heart failure, malignancy, revascularization, or statin use. Ongoing ezetimibe therapy during follow-up was associated with lower mortality in time-dependent analysis (adj. HR 0.53; CI 0.48-0.59; p<0.0001). Conclusion Ezetimibe is associated with lower risk of death after MI, but therapy use is limited and discontinuity is frequent.

Ezetimibe use and mortality after myocardial infarction: A nationwide cohort study

BackgroundThe inhibition of intestinal cholesterol absorption by ezetimibe improves outcomes after myocardial infarction (MI), yet real-world data on ezetimibe is scarce. We studied the usage of ezetimibe and association with outcome after MI. MethodsConsecutive MI patients in Finland (2010–2018) were retrospectively studied (N = 57,505; 65 % men; mean age 69 years). The study data were collected from national registries. The median follow-up was 4.5 (IQR 2.8–7.1) years. Between-group differences were adjusted for using multivariable regression. Ezetimibe use was studied with competing risk analyses. ResultsThe cumulative incidence of ezetimibe use was 3.7 % at 90 days, 13.4 % at 5 years, and 19.8 % at 10 years. Younger age was one of the strongest predictors of ezetimibe use (adj.sHR 6.67; CI 5.88–7.69 for patients aged <60 vs ≥80 years). Women were more likely to use ezetimibe during follow-up than men. The average proportion of patients using ezetimibe during follow-up was 6.8 %. (11.7 % at 10 years). Ezetimibe was discontinued by 43.6 % of patients during follow-up. Patients with early ezetimibe therapy after MI had lower all-cause mortality during follow-up (33.6% vs 45.1 %; adj.HR 0.77; CI 0.69–0.86; P < 0.0001). Early ezetimibe use was associated with lower mortality irrespective of sex, age, atrial fibrillation, diabetes, heart failure, malignancy, revascularization, or statin use. Ongoing ezetimibe therapy during follow-up was associated with lower mortality in a time-dependent analysis (adj.HR 0.53; CI 0.48–0.59; P < 0.0001). ConclusionsEzetimibe is associated with a lower risk of death after MI, yet its therapeutic use is limited, and discontinuation is frequent.

Effectiveness of buffered acetylsalicylic acid compared to other drugs in diseases patients in clinical practice: results of the CARDINAL observational retrospective study

Aim. To evaluate the effectiveness of acetylsalicylic acid (ASA) drugs for secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in clinical practice and compare the effectiveness of the Cardiomagnyl with other ASA drugs.Material and methods. This observational, non-interventional, retrospective study included data from electronic medical records of 18199 patients with ASCVD who were divided into 2 following groups: patients who received ASA 75-100 mg (n=9784) and patients who did not receive ASA (n=8325). The prescription rate of ASA, the choice of the first drug, the duration of ASA therapy, the frequency of switching ASA during treatment, and the choice of the second ASA drug when changing therapy were assessed. Due to the heterogeneity of patients in the above groups, to assess the clinical outcomes, propensity score matching was performed and comparable groups were selected to evaluate the effectiveness of ASA drugs 75-100 mg in patients with ASCVD (n= 427) in comparison with patients not receiving ASA (n=427) and to assess the effectiveness of Cardiomagnyl 75 mg (n=1308) in comparison with enterosoluble ASA 100 mg (CRA) (n=1308) taking into account 24 parameters.Results. The average proportion of patients with ASCVD taking ASA drugs was 58%. During treatment, 54% of patients underwent a change in drug therapy from one ASA drug to another. The prescription rate of Cardiomagnyl as a first-choice drug was 33%, and as a second drug when changing therapy — 21%. The duration of Cardiomagnyl therapy was the longest compared to other ASA drugs and amounted to 16,3 months. The incidence of ischemic stroke, myocardial infarction and major adverse cardiovascular events in the group of patients who received ACS 75-100 mg was significantly lower than in patients who did not take ASA drugs and amounted to 4,7% vs 8,7%, 0,9% vs 3,3%, 5,6% vs 11,9%, respectively. Significantly lower incidence of unstable angina (0,8% vs 2,0%), myocardial infarction (1,5% vs 3,9%) and major adverse cardiovascular events (5,4% vs 7,8%) in group of patients who received Cardiomagnyl 75 mg as opposed to enterosoluble ASA.Conclusion. Significant advantages of buffered ASA (Cardiomagnyl) were revealed in comparison with enterosoluble ASA in clinical practice.

Eye Rubbing in Chinese Patients With Keratoconus: A Multicenter Analysis.

To investigate the eye rubbing habits of Chinese patients with keratoconus. This study was carried out from 2018 to June 2022 at Shandong Eye Hospital, Qingdao Eye Hospital, and Henan Eye Hospital. The study compared the number of patients who rubbed their eyes between medical records and second time questionnaires, eye rubbing of patients with myopia and patients with keratoconus, and disease severity between patients with keratoconus. A questionnaire survey of ophthalmologists was conducted to determine their degree of awareness that eye rubbing is a risk factor for keratoconus. The study assessed 799 patients with keratoconus and 798 control patients, and 97 ophthalmologists. The average proportion of patients with keratoconus who rubbed their eyes was 31.0% in the medical records with an increasing trend related to the increase in ophthalmologists' awareness, 66.6% after the second follow-up, and 25.4% among patients with myopia. After multivariate analysis, the following variables showed significant results: eye rubbing frequency more than 10 times/day (odds ratio [OR], 9.168; P < .001); rubbing with knuckles (OR, 9.804; P = .001); and prone sleep position (OR, 12.427; P < .001). The proportion of patients who rubbed their eyes with stage IV keratoconus was 71.9%, 18.9% higher than those with stage I, 4.8% higher than stage II, and 17.8% higher than stage III. The proportion of Chinese patients with keratoconus who rubbed their eyes was relatively high. The main reasons for the low proportions reported were lack of attention. Clinical attention should be paid to eye rubbing in patients with keratoconus who should be educated to avoid it. [J Refract Surg. 2023;39(10):712-718.].

Lack of Statin Therapy and Outcomes After Ischemic Stroke: A Population-Based Study.

Statin treatment is effective at preventing adverse vascular events after ischemic stroke (IS). However, many patients fail to use statins after IS. We studied the impact of not using statins after IS on adverse outcomes. IS patients (n=59 588) admitted to 20 Finnish hospitals were retrospectively studied. Study data were combined from national registries on hospital admissions, mortality, cancer diagnoses, prescription medication purchases, and permissions for special reimbursements for medications. Usage of prescription medication was defined as drug purchase within 90 days after hospital discharge. Ongoing statin use during follow-up was analyzed in 90-day intervals. Differences in baseline features, comorbidities, other medications, and recanalization therapies were balanced with inverse probability of treatment weighting. Median follow-up was 5.7 years. Statin therapy was not used by 27.1% of patients within 90 days after IS discharge, with women and older patients using statins less frequently. The average proportion of patients without ongoing statin during the 12-year follow-up was 36.0%. Patients without early statins had higher all-cause mortality at 1 year (7.5% versus 4.4% in patients who did use statins; hazard ratio [HR], 1.74 [CI, 1.61-1.87]) and 12 years (56.8% versus 48.6%; HR, 1.37 [CI, 1.33-1.41]). Cumulative incidence of major adverse cerebrovascular or cardiovascular event was higher at 1 year (subdistribution HR, 1.36 [CI, 1.29-1.43]) and 12 years (subdistribution HR, 1.21 [CI, 1.18-1.25]) without early statin use. Cardiovascular death, recurrent IS, and myocardial infarction were more frequent without early statin use. Early statin use was not associated with hemorrhagic stroke during follow-up. Lack of ongoing statin during follow-up was associated with risk of death in time-dependent analysis (adjusted HR, 3.03 [CI, 2.96-3.23]). Lack of statin treatment after IS is associated with adverse long-term outcomes. Measures to further improve timely statin use after IS are needed.

The role of thrombocytopenia in the clinical management of patients with liver cirrhosis: opinion of experts in therapeutic and surgical hepatology

Seven of the country’s leading experts in the field of therapeutic and surgical hepatology answer questions on this issue: how relevant is thrombocytopenia in patients with CLD for clinical practice, what is the average proportion of patients who need correction of thrombocytopenia before scheduled and emergency surgical/invasive interventions and how is thrombocytopenia correction performed. All experts are unanimous in the opinion that thrombocytopenia is most common at the stage of cirrhosis. Further, the experts discussed the issues of the total number of patients with CLD, the proportion of patients with thrombocytopenia at all, the proportion of patients with thrombocytopenia in need of surgical interventions, the experts were asked to provide schemes for correcting thrombocytopenia, which they use in their clinical practice. The focus of the experts’ attention was on the discussion of patients who have a platelet level of less than 50 000/µl and need scheduled surgical interventions / invasive procedures. All experts unanimously stratify these interventions according to the risk of hemorrhagic complications: high – more than 1.5%, low – less than 1.5%. The most common and available method for the correction of thrombocytopenia at present is platelet transfusion. Details of all this information, as well as statistical data, can be found in this article.

Meta-Analysis of Nonrandomized Studies to Assess the Optimal Timing of Coronary Artery Bypass Grafting After Acute Myocardial Infarction

The optimal timing of coronary artery bypass grafting (CABG) in patients after an acute myocardial infarction (MI) is unknown. We performed a systematic review and meta-analysis of studies comparing mortality rates in patients who underwent CABG at different time intervals after acute MI. Bias assessments were completed for each study, and summary of proportions of all-cause mortality were calculated based on CABG at various time intervals after MI. A total of 22 retrospective studies, which included a total of 137,373 patients were identified. The average proportion of patients who died when CABG was performed within 6hours of MI was 12.7%, within 6 to 24hours of MI was 10.9%, within 1day of MI was 9.8%, any time after 1day of MI was 3.0%, within 7days of MI was 5.9%, and any time after 7days of MI was 2.7%. Interstudy heterogeneity, assessed using I2 values, showed significant heterogeneity in death rates within subgroups. Only 1 study accounted for immortal time bias, and there was a serious risk of selection bias in all other studies. Confounding was found to be a serious risk for bias in 55% of studies because of a lack of accounting for type of MI, MI severity, or other verified cardiac risk factors. The current publications comparing timing of CABG after MI is at serious risk of bias because of patient selection and confounding, with heterogeneity in both study populations and intervention time intervals.

How government health insurance coverage of novel anti-cancer medicines benefited patients in China \u2013 a retrospective analysis of hospital clinical data

BackgroundChina started to cover novel medicines for the treatment of major cancers, such as trastuzumab for breast cancer by the government health insurance programs since 2016. Limited data have been published on the use of cancer medications and little is known about how government health insurance coverage of novel anti-cancer medicines benefited patients in the real world. This study aimed to generate evidence to inform the health security authorities to optimize the government health insurance coverage of novel anti-cancer medicines as a more inclusive and equal policy, through which each of the needed patient can get access to the novel anti-cancer medicines regardless of the ability to pay.MethodsThe study targeted one of the government health insurance newly covered novel medicines for breast cancer and the breast cancer patients. The analyses were based on the data collected from one tertiary public hospital in Fujian province of China. We conducted interrupted time series analysis with a segmented regression model and multivariate analyses with a binary logistic regression model to analyze the impact of the government health insurance coverage on medicines utilization and the determinants of patient’s medication choice.ResultsThe average proportion of patients who initiated medication with novel medicines increased from 37.4% before the government health insurance coverage to 69.2% afterwards. Such an increase was observed in all patient sub-groups. The monthly proportion of patients who initiated medication with novel medicines increased sharply by 18.3 % (95 %CI,10.4-34.0 %, p = 0.01) in September 2017, the afterwards trend continuously increased (95 %CI,1.03–3.60, p = 0.02). The critical determinants of patient's medication choice were mostly connected with the patient's health insurance benefits packages.ConclusionsThe government health insurance coverage of novel anti-breast-cancer medicines benefited the patients generally. The utilization of novel medicines such as trastuzumab continuously increased. The insurance coverage benefited well the patients in the high-risk age groups. However, rural patients, patients enrolled in the “resident program”, and patients from low-income residential areas and non-local patients benefited less from this policy. Improving the benefits package of the low-income patients and the “resident program” beneficiary would be of considerable significance for a more inclusive and equal health insurance coverage of novel anti-cancer medicines.

Generalisability of randomised trials evaluating perioperative β-blocker therapy in noncardiac surgery

BackgroundThe limited applicability of evidence from RCTs in real-word practice is considered a potential bottleneck for evidence-based practice but rarely systematically assessed. Using our failure to recruit patients into a perioperative beta-blocker trial, we set out to analyse the restrictiveness and generalisability of trial eligibility criteria in a real-world cohort. MethodsWe prospectively included adult patients (≥18 yr) scheduled for elective noncardiac surgery at an academic tertiary care facility who were screened for inclusion in a planned perioperative beta-blocker RCT, which was terminated owing to recruitment failure. The primary outcome was the proportion of screened patients who matched the eligibility criteria of 36 published RCTs included in a large Cochrane meta-analysis on perioperative beta-blocker therapy. The pragmatic/explanatory level of each RCT was assessed using the PRagmatic–Explanatory Continuum Indicator Summary 2 (PRECIS-2) score, which ranges from 9 points (indicating a very explanatory study) to 45 points (indicating a very pragmatic study). ResultsA total of 2241 patients (54% female, n=1215; 52 [standard deviation, 20] yr) were included for the assessment of trial eligibility between October 2015 and January 2016. Only a small proportion of patients matched the inclusion and exclusion criteria for each of the 36 RCTs, ranging from 53% to 0%. The average proportion of patients who did match the eligibility criteria of all 36 RCTs was 6.5% (n=145; 95% confidence interval, 6.3–6.6). A higher PRECIS-2 score was associated with a higher proportion of matching patients (P<0.001). ConclusionsTrial eligibility criteria in perioperative beta-blocker therapy trials are overly restrictive and not generalisable to a real-world surgical population. Clinical trial registrationEudraCT#: 2015-002366-23.

Endovascular Intervention Versus Surgery in Ruptured Intracranial Aneurysms in Equipoise

Background and Purpose- The benefits of endovascular intervention over surgery in the treatment of ruptured aneurysms of anterior circulation remains uncertain. Recently, published studies did not find superiority of endovascular intervention, challenging earlier evidence from a clinical trial. The earlier evidence also had a higher than average proportion of patients in good clinical status, leading to uncertainty about external validity of earlier trials. Methods- We performed a systematic review of studies after 2005 under a protocol published in the International Prospective Register of Systematic Reviews. Primary outcomes were posttreatment rebleeding and adverse events (procedural complications). Secondary outcomes were dependency at 3 to 6 and 12 months, delayed cerebral ischemia, and seizures. Results- Rebleeding was more frequent after endovascular intervention (Peto OR, 2.18 [95% CI, 1.29-3.70]; 3104 participants; 15 studies; I2=0%, Grading of Recommendations, Assessment, Development and Evaluation: very low certainty of evidence). Fewer adverse events were reported with the endovascular intervention (RR, 0.71 [95% CI, 0.53-0.95]; 1661 participants; 11 studies; I2=14%, Grading of Recommendations, Assessment, Development and Evaluation: low certainty of evidence). Three to six months dependency (RR, 0.82 [95% CI, 0.73-0.93]; 4081 participants; 18 studies; I2=15%, Grading of Recommendations, Assessment, Development and Evaluation: low certainty of evidence) and 12-month dependency (RR, 0.76 [95% CI, 0.66-0.86]; 1981 participants; 10 studies; I2=0%, Grading of Recommendations, Assessment, Development and Evaluation: low certainty of evidence) were lower after endovascular intervention. Conclusions- This study found consistent results between recent studies and the earlier evidence, in that endovascular intervention results in lower chance of dependency compared with surgery for repair of ruptured anterior circulation aneurysms. A lower proportion of patients in good clinical status in this review supports the application of the earlier evidence. Registration- URL: https://www.crd.york.ac.uk/PROSPERO. Unique identifier: CRD42018090396.

Temporal trends in fluid management with incremental hemodialysis .

Incremental hemodialysis (HD) is seldom prescribed in the United States. This study describes longitudinal changes in volume management in patients with incident end-stage kidney disease (ESKD) initiated on bi-weekly (twice a week) HD, later converted to thrice-weekly HD. 23 patients (mean age 65.6 years, 48% male, and 30% black) were included. Repeated measurement analysis of regression was used to test for differences in interdialytic weight gain (IDWG) and ultrafiltration rate (UFR) over three dialysis periods: the first 3months of bi-weekly HD, the last 3 months of bi-weekly HD, and the first 3months of thrice-weekly HD. The mean transition time to thrice-weekly HD was 332.9 days. Compared to the first 3 months of HD, the IDWG and UFR increased by 0.6 kg and 2.2 mL/kg/h in the last 3 months of bi-weekly HD (p = 0.02 and 0.009, respectively) and by 0.7 kg and 2.1 mL/kg/h in the first 3 months of thrice-weekly HD (p = 0.002). The average proportion of patients with IDWG > 5.7% of the dry weight was 0% in the first 3 months of bi-weekly HD, 12% in the last 3 months of bi-weekly HD, and 4% in the first 3 months of thrice-weekly HD; while the average proportion of patients with UFR > 10mL/kg/h was 16%, 39%, and 25%, respectively. Fluid management in incident-ESKD patients receiving bi-weekly HD deteriorates prior to conversion to thrice-weekly HD. Further studies are needed to optimize the prescription of incremental HD.

PB2262 HEALTHCARE RESOURCE UTILIZATION (HRU) ASSOCIATED WITH MINIMAL RESIDUAL DISEASE (MRD) STATUS IN ADULTS WITH B‐CELL PRECURSOR (BCP) ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)

Background:The presence of MRD is the most important risk factor for relapse and mortality in patients with BCP ALL who achieve complete remission (CR). Given the poor outcomes associated with MRD‐positive (MRD+) ALL, achieving MRD‐negativity (MRD‐) is critical. However, the HRU associated with MRD status is unknown.Aims:To investigate the HRU associated with MRD status among adult patients with BCP ALL in first CR (CR1) in France, Germany, Italy, Spain and UK (EU5).Methods:A cross‐sectional survey of physicians who use MRD testing in adults with BCP ALL in the EU5 countries was used to estimate the HRU. Physicians must be board‐certified or specialized in hematology/hemato‐oncology, have ≥ 5 years’ experience with ALL, have seen ≥ 2 ALL patients in the last 12 months or ≥ 5 patients in the last 5 years, and have experience using MRD testing in clinical practice. Two to 4 physicians were recruited in each country. Each physician completed a web‐based questionnaire and was followed by a telephone interview. Descriptive analyses were conducted. Outpatient visits to healthcare professionals and hospital resource use for ALL patients in CR1 with or without MRD during an average period of 6 months (assuming no relapse or allogeneic hematopoietic stem‐cell transplant occurred) were reported for each country and across countries.Results:According to the survey, across the countries, patients with MRD+ ALL had an average of 9.2 (ranging 4∼12) visits to hematologist/oncologist, 1.4 (0∼2.5) visits to radiologist, 1.8 (0∼3) visits to other specialist physician and 2.6 (0∼4.5) visits to general physician during a 6‐months period, compared with 7.4 (1∼11), 1.1 (0∼2.3), 1.4 (0∼2.3) and 2.3 (0∼4.0) visits, respectively, in patients with MRD‐ ALL (Table 1). The average proportion of patients with at least one hospital admission in patients with or without MRD was 64.7% (ranging 40.0%∼83.3%) vs 39.3% (0∼83.3%). Of the patients with at least admission, patients with MRD+ ALL had an average of 3.2 (1.5∼4.3) admissions with a mean length of stay (LOS) of 13.2 (0.5∼19.8) days per admission, compared with 2.1 (0∼4.3) admissions and a mean LOS of 8.9 (0∼15.3) days per admission in patients with MRD‐ ALL (Table 2).Summary/Conclusion:From the physicians’ estimates of the HRU for patients with ALL in CR1 in the EU5 countries, presence of MRD+ is generally associated with higher use of outpatient visits to physicians across different specialties and with higher use of hospital resources (except Spain). The results should be interpreted with the limitation of small sample sizes in each country.image

Clinical Outcomes of Patients with Type 2 Diabetes Treated with Multiple Daily Injection (MDI) of Insulin—A Retrospective Cohort Analysis

Objective: We retrospectively analyzed clinical outcomes in type 2 diabetes mellitus (T2DM) multiple daily injections (MDI) insulin therapy patients compared with non-MDI insulin therapy patients. MDI was defined as patients having at least one basal and one prandial/bolus insulin prescription during a one year period starting October 2015. Methods: We compared a cohort of patients with an ICD-10 code of E11, 18 years of age and older, not pregnant, with a minimum of one office visit between October 2015 and April 2016. Data such as HbA1c, LDL, Body Mass Index (BMI), cardiovascular and renal disease were pooled from one hospital EMR system in the southeastern United States for MDI (n=11742) and non-MDI (n=56025) patients. T-tests were conducted. Results: All mean differences were significant (p&amp;lt;0.001). Overall, the average patient population in the MDI group was 2.4 years younger with a slightly larger proportion of female gender in the MDI group. Patients in the MDI group had an average HbA1c of 8.3% (SD=1.9) vs. 7.2% (SD=1.4) in the non-MDI group, but average proportion of patients with glycemic control (HbA1c &amp;lt;7%) was 23.9% vs. 54.8% respectively. The rate of cardiovascular disease in the MDI group was 37.8% vs. 21.8% in the non-MDI group. The rates of renal disease in the MDI group at 30.8% far exceeded the rates in the non-MDI group at 13.5%. Average BMI of 33.9 kg/m2 (SD=8.4) in the MDI group was greater than the non-MDI group at 32.9 kg/m2 (SD=8.6). The percentage of patients with blood pressure less than 140/90 mmHg was 78.3% in the MDI group vs. 81.4% in the non-MDI group, but the average LDL was 87.4 mg/dL (SD=37.4) vs. 88.7 mg/dL (SD=32.2) respectively. Conclusion: These results suggest MDI insulin therapy patients have poorer glycemic control and greater rates of macro and micro vascular complications compared with non-MDI insulin therapy patients within a large healthcare system. Disclosure T. Ludden: None. A. Ermakova: Employee; Self; Becton, Dickinson and Company. Y. Xiong: Employee; Self; Becton, Dickinson and Company. R. Sieradzan: Employee; Self; Becton, Dickinson and Company. N.C. Sacks: Consultant; Self; Becton, Dickinson and Company. P.L. Cyr: Consultant; Self; Becton, Dickinson and Company. S. Phillips: None. S.D. Taylor: Employee; Self; Becton, Dickinson and Company.

Very long-term outcome of schizophrenia.

The principal aim is to review recent data concerning the very long-term outcome of schizophrenia and schizophrenia spectrum disorders. We examine factors that influence outcome, including therapeutic interventions. PubMed and Scopus databases were searched for papers published between 2008 and 2017 reporting on prospective studies of schizophrenia or schizophrenia spectrum with a follow-up period ≥5years with adequate outcome information. Additional publications were found in reference lists and authors' reference libraries. The average proportion of patients with symptomatic remission at follow-up ranged between 16.4% in never-treated patients to 37.5% in patients who were systematically treated with antipsychotics. Good outcomes at follow-up were observed in schizophrenia and schizophrenia spectrum patients on low doses of antipsychotics and in patients with no pharmacological treatment at that time. Early detection and intensive treatment of the first episode as well as the availability of continued psychosocial treatment and support over subsequent years appeared associated with better outcomes. The long-term outcome of schizophrenia is highly variable, depending on access to mental healthcare, early detection of psychosis and pharmacological treatment. Recent data support the effectiveness of low-dose antipsychotic treatment for long-term maintenance in some patients. A proportion of first-episode schizophrenia patients, perhaps 20%, do not need long-term maintenance antipsychotic treatment. That proportion may be higher in schizophrenia spectrum patients. The reasons why these patients do not need the long-term treatment are not well understood. Methods to predict the membership in this subgroup are not yet good enough for clinical use in individual patients.

TREATMENT RECOMMENDED AND RECEIVED FOLLOWING DIAGNOSTIC CATHETERIZATION FOR CORONARY ARTERY DISEASE IN BC, 2001-2012

Coronary revascularization procedures including percutaneous coronary interventions (PCIs) and coronary artery bypass graft (CABG) are important elements in the treatment of patients with coronary artery disease (CAD). Tracking the procedures that patients received after diagnostic catheterization (DiagCath) provides insight on how CAD patients have been managed. The Cardiac Servives BC Registry allows a unique opportunity to explore trends over a decade of population-based longitudinal clinical data. This study describes the recommended and received revascularization Methods after DiagCath in BC from 2001 to 2012. On average more than 16,000 DiagCaths were performed each year from 2001 to 2012 in BC. Cases with age ≤20, non-BC residents, indications other than ACS/stable angina, and with normal angiograms were excluded. Overall the proportion of patients recommended after DiagCath to undergo PCI was 47.6%, 19.4% for CABG, 25.4% for medical management, and 7.6% didn’t have recommendation. However, the proportion of patients who actually received PCI within 90 days post DiagCath was 53.6%, received CABG within 180 days was 15.9% and 30.5% was managed by medications. Among patients with treatment recommendations from DiagCath, most (89.1%) received the recommended treatments, and the proportion of patients receiving recommended treatments has significantly increased over time (p-value<.001) from 85.0% in 2001 to 91.6% in 2012 (Figure 1). Figure 1 shows that proportions of being recommended for a PCI and actually receiving PCI within 90 days were very closely tied, on average 95.1%. The proportion of being recommended for CABG was consistently higher than the proportion of patients actually receiving CABG within 180 days. The average proportion of patients who were referred for CABG but did not undergo a surgery was 26.3%. The proportion of patients who were referred for CABG but refused and opted to receive PCI within 90 days was 6.5%. We described the treatment recommended and received longitudinally for a large cohort of patients undergoing DiagCath. The majority of patients received the treatment that was recommended at DiagCath. From 2011 to 2012, a large decrease in PCI and increase in medical management of both recommended and received treatments were observed. Surgical turndowns are known to have significant worse outcomes. The reasons for large percent of surgical turndown are unknown and warrant further investigation. This study provides a valuable picture of cardiac procedure used following DiagCath and indicates a clear need for close monitoring and more comprehensive study of the recommendation and treatment process.

Trends and Regional Variation in Opioid Overdose Mortality Among Veterans Health Administration Patients, Fiscal Year 2001 to 2009

Opioid-related mortality has increased in the United States in the past decade. The purpose of this study was to examine trends and regional variation in opioid prescribing and overdose rates in a national health system, the Veterans Health Administration. Annual cohorts of Veterans Health Administration patients were identified on the basis of medical records, and overdose mortality was determined from National Death Index records. State-level prescribing and overdose rates were mapped to provide information on regional variability. There were significant increases between 2001 and 2009 in the rate of overdoses associated with nonsynthetic opioids (β=0.53, 95% confidence interval, 0.35, 0.70) and methadone (β=0.63, 95% confidence interval, 0.37, 0.90) but not synthetic/semisynthetic opioids. State-level overdose rates had a moderate correlation with the average proportion of patients in that state receiving opioids (r=0.29). The present study demonstrates that the increases in prescription opioid overdoses observed in the general population are also found in the patient population of a national health system and provides further evidence of the population-level association between trends in opioid prescribing and opioid overdose deaths. There is substantial regional variation in both opioid prescribing and opioid-related overdose rates, and these data can inform region-specific overdose prevention strategies and opioid policy.

Post-operative Weight Gain After Total Knee Arthroplasty: Prevalence and Its Possible Attenuation Using Intraoperative Sensors

As the proportion of adults with obesity continues to climb, so too does the need for total knee arthroplasty. Unfortunately, total knee replacement patients often experience post-operative weight gain, despite improved joint function. The purposes of this study were: 1) To execute a literature meta-analysis in order quantify the changes in body mass that are typically observed following TKA, and 2) Evaluate data from a prospective, multicenter study to assess any trends towards weight loss in a group of “balanced”, sensor-assisted TKA patients. The literature review found that average proportion of patients who had weight gain after TKA is 47% to 66%. In literature, the average post-operative weight gain was 9.5 lbs. (1.6 kg/m2 BMI increase), up to 14 lbs. (2.3 kg/m2). In the multicenter study, only 30.4% of patients and 36.9% of patients exhibited weight gain at 6 months and 1 year, respectively. At the 1-year interval, this indicates an 11% decrease from reported averages (p=0.049), up to 29% as reported by the NIH (p&lt;0.001). The average weight gain in the multicenter patient group was 4.3 lbs. (0.72 kg/m2 BMI increase) at 6 months, and 3.5 lbs. (0.58 kg/m2) at 1 year, both of which are non-clinically meaningful. The average weight loss of those in the non-gaining group was 7.8 lbs. (1.3 kg/m2) at 6 months and 9.6 lbs. (1.6 kg/m2) at 1 year. Both of these values are clinically meaningful. This evaluation demonstrates that weight gain after TKA is prevalent, but ensuring soft-tissue balance (via technologies such as intraoperative sensing) may help mitigate this expected increase in body mass.Keywords: total knee arthroplasty, increased BMI, intraoperative sensors, weight gain, obesity

Revisiting the multi-armed bandit model for the optimal design of clinical trials: benefits and drawbacks

In a traditional randomised clinical trial, patients are allocated to an experimental treatment or the standard therapy arm - with equal probability - for its entire duration. However, using data from past patients to change allocation probabilities for future patients can increase the average number of patients who receive the best treatment. A drawback of doing this is that the power of the trial can be considerably reduced. The Bernoulli Multiarmed bandit problem (MABP) is an idealised model that illustrates such a conflict. For such model, Gittins & Jones (1974) provided a rule that maximises the expected patient benefit in a large trial. Bandit models for clinical trials have been extensively studied in theory, yet the resulting schemes have been rarely used in practice. There are many reasons for this, however the power limitations to detect a significant treatment effect is a major drawback. In this presentation, we discuss allocating patients between several experimental treatments and a shared control group in a multi-arm trial, using the Gittins index. We modify the MABP design so that the shared control group is allocated separately to protect the power of the trial. The design provides considerable gains not only in efficiency over separate randomised trials but also in the average proportion of patients allocated to the best experimental treatment. This design can be advantageously extended for trials in rare diseases, where it becomes particularly relevant to optimize the choice of treatment both for patients in the trial and for those to treat after it.

FRI0406 Prevalence estimate and gender distribution of axial spondyloarthritis among patients in us rheumatology practices

BackgroundThe ASsessment in Ankylosing Spondylitis (ASAS) international Society working group has proposed and validated new classification criteria for patients with axial SpA.1 Currently, there are no epidemiology data specific to...

Patient Satisfaction with Medication for Gastroesophageal Reflux Disease: A Systematic Review

Patient satisfaction is increasingly regarded as an important aspect of measuring treatment success in individuals with gastroesophageal reflux disease (GERD). To review how satisfied patients with GERD are with their medication, and to analyze the usefulness of patient satisfaction as a clinical end point by comparing it with symptom improvement. Systematic searches of the PubMed and EMBASE databases identified clinical trials and patient surveys published between 1966 and 2009. Twelve trials reported that 56% to 100% of patients were 'satisfied' or 'very satisfied' with proton pump inhibitor (PPI) treatment for GERD. Patient satisfaction levels were higher for PPIs than other GERD medications in two trials. The sample-size-weighted average proportion of patients 'satisfied' with their PPI after four weeks of treatment in trials was 93% (95% CI 87% to 99%), with 73% (95% CI 62% to 83%) being 'very satisfied'. In four surveys, the average proportion of patients 'satisfied' with their PPI treatment was 82% (95% CI 73% to 90%) and 62% (95% CI 48% to 75%) were 'very satisfied'. Seven trials found a positive association between patient satisfaction and symptom improvement, and two surveys between satisfaction and improved health-related quality of life. Three trials found that continuous treatment yielded higher rates of satisfaction than on-demand therapy. More than one-half of patients were satisfied with their PPI medication in trials, and more patients were satisfied with PPIs than other medication types. An association between patient satisfaction and symptom resolution was found, suggesting that patient satisfaction is a useful end point for evaluating GERD treatment success.