Chronic Comorbid Conditions Research Articles

Changes in chronic disease medication adherence following oral anticancer agent initiation in patients with multiple myeloma.

e18760 Background: Improvements in treatment options for multiple myeloma (MM) have led to double-digit increases in 5-year survival rates over the past 40 years. Such extended survival has increased emphasis for the management of comorbid chronic conditions. Initial analyses suggest that oral anticancer agent (OAA) initiation for MM may correspond to significant reductions in adherence to chronic disease medications. Methods: This was a retrospective cohort study of adults diagnosed with and being treated for MM between 2013-2018 using data from the IBM MarketScan Commercial Claims and Encounters databases and a 20% sample of Medicare claims data. Adults (18 years and older) were included if they were diagnosed with and had at least two claims for an OAA indicated for MM, had continuous enrollment for 12 months both before and after OAA initiation, and were previously diagnosed with two chronic conditions and had prescription fills for select chronic conditions. Medication adherence was determined using the proportion of days covered (PDC) metric and was compared for the 12 months before and after the OAA initiation by Wilcoxon signed-rank tests, McNemar’s tests, and difference-in-differences (DinD) models. Results: A slight majority of the 2,765 patients (total N from both databases) were male (52.3%), and hypertension (94.5%) and hyperlipidemia (69.2%) were the most common comorbid conditions. Mean OAA adherence in the first year of therapy was 55.8% (SD: 23.5) and 63.5% (SD: 26.9) for commercial and Medicare patients, respectively. PDCs for comorbid therapies declined in the first year after OAA initiation, irrespective of payer (table), and the proportion adherent to these therapies (PDC > 80%) also declined consistently. OAA adherence tended to align with the direction of changes in comorbid therapy adherence with those nonadherent to their OAA (PDC < 80%) demonstrating general declines in comorbid therapy PDCs post-OAA initiation (p<0.05 in 4 of 6 DinD models). Conclusions: Among adults with MM and multiple chronic conditions, the pre-OAA initiation level of adherence appears to dictate chronic disease medication use patterns after OAA initiation. The starting of OAA therapy facilitates an opportunity for providers to reinforce the need for total regimen adherence to improve the odds of positive cancer- and non-cancer-related outcomes. [Table: see text]

Comorbidity Profiles and Lung Cancer Screening among Older Adults: U.S. Behavioral Risk Factor Surveillance System 2017-2019.

Rationale: Although lung cancer screening (LCS) with low-dose computed tomography (LDCT) is now recommended for those meeting standard risk factor-based eligibility criteria, the role of comorbidity in the uptake of LCS with LDCT in an older real-world U.S. population is not well established. Objectives: To examine the relationships between comorbidity, functional status, and LCS utilization in the United States. Methods: Using population-based data from the 2017-2019 Behavioral Risk Factor Surveillance System, we examined the association of comorbid conditions and functional limitations regarding activities of daily living with LCS utilization among participants that met the LCS criteria based on the U.S. Preventive Service Taskforce guidelines. We employed multivariable weighted logistic regression models to evaluate these associations, both overall and within subgroups defined by age (<65 yr vs. ⩾65 yr), sex, and smoking history. Results: Of 11,214 participants who met the eligibility criteria for LCS, 1,731 (16%) underwent LCS with LDCT. The majority were White (90%), male (55%), former smokers (52%), and living with at least one chronic comorbid condition (77%). More than 28% had three or more comorbid conditions, and approximately 40% of participants reported having some form of functional limitations. In the multivariable models, the likelihood of undergoing LCS with LDCT within the past year was positively associated with higher amount of comorbidity (⩾5 vs. 0: adjusted odds ratio, 2.34; 95% confidence interval [CI], 1.22-4.48) but not with functional limitations (⩾3 vs. 0: adjusted odds ratio, 1.00; 95% CI, 0.66-1.50). Conclusions: The presence of comorbid conditions is associated with a higher likelihood of undergoing LCS with LDCT. Because poor health status may diminish the benefits of screening, future research is needed to precisely characterize the health status of LCS-eligible individuals.

A Man Named Peter: Living in Long-Term Care as a Younger Adult

A Man Named Peter: Living in Long-Term Care as a Younger Adult

Differential Activation of Colonic Afferents and Dorsal Horn Neurons Underlie Stress-Induced and Comorbid Visceral Hypersensitivity in Female Rats

Chronic Overlapping Pain Conditions, including irritable bowel syndrome (IBS) and temporomandibular disorder (TMD), represent a group of idiopathic pain conditions that likely have peripheral and central mechanisms contributing to their pathology, but are poorly understood. These conditions are exacerbated by stress and have a female predominance. The presence of one condition predicts the presence or development of additional conditions, making this a significant pain management problem. The current study was designed to determine if the duration and magnitude of peripheral sensitization and spinal central sensitization differs between restraint stress-induced visceral hypersensitivity (SIH) and chronic comorbid pain hypersensitivity (CPH; stress during pre-existing orofacial pain). SIH in female rats, as determined by the visceromotor response, persisted at least four but resolved by seven weeks. In contrast, CPH persisted at least seven weeks. Surprisingly, colonic afferents in both SIH and CPH rats were sensitized at seven weeks. CPH rats also had referred pain through seven weeks, but locally anesthetizing the colon only attenuated the referred pain through four weeks, suggesting a transition to colonic afferent independent central sensitization. Different phenotypes of dorsal horn neurons were sensitized in the CPH rats seven weeks post stress compared to four weeks or SIH rats. The current study suggests differential processing of colonic afferent input to the lumbosacral spinal cord contributes to visceral hypersensitivity during comorbid chronic pain conditions. PerspectiveChronic Overlapping Pain Conditions represent a unique challenge in pain management. The diverse nature of peripheral organs hinders a clear understanding of underlying mechanisms accounting for the comorbidity. This study highlights a mismatch between the condition-dependent behavior and peripheral and spinal mechanisms that contribute to visceral pain hypersensitivity.

Enhancing Diabetes Self-Management Education and Psychological Services for Veterans With Comorbid Chronic Health and Mental Health Conditions.

Veterans experience a higher prevalence of type 2 diabetes mellitus (T2DM) compared with the rate of their civilian counterparts. Veterans may experience vulnerability to chronic stress, in particular comorbid mental health conditions, and may not benefit from traditional diabetes education. This study evaluated clinical and psychological measures among veterans engaged in health psychology services. Individualized motivational interviewing and cognitive behavioral interventions were provided to address T2DM distress and promote veterans' diabetes self-management. Pre-/postobjective and self-report measures were evaluated for clinical relevancy and statistically significant changes. The sample consisted of 13 older adults: mean age 62.8 years; 12 were male and 9 were prescribed insulin. More than half had comorbid hypertension, hyperlipidemia, and/or a diagnosis of chronic pain. Eleven participants were diagnosed with a mental health disorder. Baseline measures indicated mild depressive symptoms, mild anxiety symptoms, and moderate levels of T2DM distress. Postintervention reductions were shown for T2DM distress; emotional burden, and regimen-related distress, depressive symptoms, and enhanced diabetes empowerment. Veterans with comorbid conditions may benefit from individualized psychology services that offer cognitive behavioral strategies for self-management of T2DM-related distress, integrated with traditional primary care and diabetes education.

Profile of Chronic Comorbid Conditions and Obstetrical Complications Among Pregnant Women With Human Immunodeficiency Virus and Receiving Antiretroviral Therapy in the United States.

To evaluate the frequency and associated characteristics of chronic comorbid conditions and obstetrical complications among pregnant women with human immunodeficiency virus (HIV) and receiving antiretroviral therapy (ART) in comparison to those without HIV. We compared 2 independent concurrent US pregnancy cohorts: (1) with HIV (International Maternal Pediatric Adolescent AIDS Clinical Trials Protocol P1025, 2002-2013) and (2) without HIV (Consortium for Safe Labor Study, 2002-2007). Outcomes were ≥2 chronic comorbid conditions and obstetrical complications. For women with HIV, we assessed whether late prenatal care (≥14 weeks), starting ART in an earlier era (2002-2008), and a detectable viral load at delivery (≥400 copies/mL) were associated with study outcomes. We assessed 2868 deliveries (n = 2574 women) with HIV and receiving ART and 211 910 deliveries (n = 193 170 women) without HIV. Women with HIV were more likely to have ≥2 chronic comorbid conditions versus those without HIV (10 vs 3%; adjusted OR [AOR]: 2.96; 95% CI: 2.58-3.41). Women with HIV were slightly less likely to have obstetrical complications versus those without HIV (both 17%; AOR: .84; 95% CI: .75-.94), but secondarily, higher odds of preterm birth <37 weeks. Late entry to prenatal care and starting ART in an earlier era were associated with a lower likelihood of ≥2 chronic comorbidities and obstetrical complications; detectable viral load at delivery was associated with a higher likelihood of obstetric complications. Pregnant women with HIV receiving ART have more chronic comorbid conditions, but not necessarily obstetrical complications, than their peers without HIV.

Palliative Wound Care for PALTC

Palliative Wound Care for PALTC

538 Profile of chronic comorbid conditions and obstetrical complications among U.S. pregnant women with HIV

To evaluate the frequency and associated characteristics of chronic comorbid conditions and obstetrical complications among pregnant women living with HIV on antiretroviral therapy, and in comparison to those without HIV. We assessed two concurrent U.S cohorts of pregnant women with and without HIV: 1) International Maternal Pediatric Adolescent AIDS Clinical Trials Protocol P1025, 2002-2013; and 2) Consortium for Safe Labor Study, 2002-2008. The primary outcomes were ≥2 chronic comorbid conditions per the WHO, and obstetrical complications. For women with HIV, we assessed whether a detectable viral load at delivery (≥400 copies/mL), starting ART earlier (less effective era, 2002-2008), and late entry to prenatal care (≥14 weeks) were associated with study outcomes. We assessed 2,868 deliveries (n=2,574 women) with HIV on antiretroviral therapy, and 211,910 deliveries (n=193,170 women) without HIV. Women with HIV were more likely to have ≥2 chronic comorbid conditions versus those without (10 vs. 3%; AOR: 2.96), including the most frequent comorbid groups, psychiatric (16 vs. 4%; AOR: 5.13), pulmonary (12 vs. 8%; AOR: 1.66), and cardiovascular (9 vs. 5%; AOR: 1.27). Women with HIV were slightly less likely to have obstetrical complications versus those without (both 17%; AOR: 0.84), including preeclampsia (both 6%; AOR: 0.80), very preterm birth <34 weeks (4 vs. 5%; AOR: 0.76), and gestational diabetes (both 4%; AOR: 0.70), but not preterm birth <37 weeks (17 vs. 13%; AOR: 1.31). Late entry to prenatal care and starting antiretroviral therapy earlier were associated with a lower likelihood of ≥2 chronic comorbidities (AORs: 0.65 and 0.72) and obstetrical complications (AORs: 0.76 and 0.76), and detectable viral load with a higher likelihood of obstetrical complications (AOR: 1.32). Chronic comorbid conditions were more frequent among pregnant women with HIV in an era of antiretroviral therapy, but not most obstetrical complications, compared to those without HIV, reinforcing the continued importance of high-risk interdisciplinary pregnancy care for this population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

89 Association of chronic comorbid disease and severe maternal morbidity among pregnant patients with influenza

Patients with chronic comorbid disease are at increased risk of morbidity and mortality from influenza, and whether this holds for pregnant patients remains to be defined. Our objective was to determine among pregnancies with influenza, whether chronic comorbid disease was associated with an increased risk of maternal morbidity. A cross sectional analysis of delivery hospitalizations complicated by influenza during pregnancy was conducted using the 2000-2015 National Inpatient Sample. Chronic comorbid conditions included chronic hypertension (cHTN), pregestational diabetes (PGDM), obesity, and obstructive lung disease (OLD). The primary outcome was severe maternal morbidity (SMM) defined by Centers for Disease Control and Prevention criteria, and secondarily, complications associated with influenza, including sepsis/shock, acute respiratory distress syndrome (ARDS), and mechanical ventilation/tracheostomy. Log linear models were used, adjusting for patient, hospital, and clinical variables. Of 62.7 million, 182,228 (0.3%) delivery hospitalizations were complicated by influenza, with a rate over 2-fold higher of 64.7 per 10,000 deliveries for patients with chronic comorbidities versus 24.4 without. Over 1 in 4 (26%, n=47, 273) deliveries with influenza had one or more chronic comorbidities and higher frequencies of SMM (2.7% vs 1.9%), ARDS (0.8% vs. 0.4%), and mechanical ventilation (0.2% vs. 0.1%) with similar rates of shock/sepsis. Among pregnant patients with influenza, those with OLD were at higher risk of SMM (adjusted risk ratio (aRR): 1.18), as well as ARDS (aRR: 1.83) and mechanical ventilation (aRR: 2.45). Patients with cHTN, obesity, and PGDM were also at elevated risks of adverse complications (Table). Among patients with influenza during pregnancy, chronic comorbid conditions, particularly obstructive lung disease, may increase the risk of maternal morbidity. Further efforts aimed at increasing influenza vaccination in pregnancy for patients with chronic comorbidities as well as optimizing pregnancy care for this population may mitigate this risk.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Hospital incidence, in-hospital mortality and medical costs of pneumococcal disease in Spain (2008–2017): a retrospective multicentre study

Objective The aim of this study was to analyze the characteristics of the patients attended with a pneumococcal disease in Spanish hospitals, to evaluate trends in hospital incidence and in-hospital mortality and to quantify patients’ use of resources and medical costs. Methods Medical admission records of patients admitted due to pneumococcal disease between 1 January 2008 and 31 December 2017 were obtained from a Spanish hospital discharge database. Records were identified with the International Statistical Classification of Diseases and Related Health Problems, 9th and 10th version codes corresponding to pneumococcal pneumonia, bacteraemia, pyogenic arthritis, endocarditis, meningitis, peritonitis and unspecified pneumococcal infections. Results Admissions of 168,074 patients were analyzed, with a mean age of 63.5 years (median = 72; interquartile range = 28). Pneumococcal pneumonia was responsible for 64.1% of all admissions, with a hospital incidence of 31.1 per 10,000 patients that decreased significantly over the study period (p = .002). Hospital incidence of meningitis also displayed a decreasing trend over the study period (p = .003), whereas incidence of bacteraemia and pyogenic arthritis increased significantly (p = .001; p = .004). Mean Charlson Comorbidity Index was 3.3 (standard deviation = 2.2). In-hospital mortality was 7.0% over the study period, being the highest in patients admitted with endocarditis (17.2%). Sepsis, acute renal failure, disorders of fluid electrolyte and acid-base balance, heart failure and acute respiratory failure were strongly associated with in-hospital mortality. Mean length of hospital stay was of 11.1 days (median = 22; interquartile range = 26) and there was a majority of urgent admissions (95.0%); the most extended stays were registered in patients with endocarditis, meningitis and pyogenic arthritis. The mean hospital admission cost was €5676, €104.2 million annually for all registered patients; 50.3% of all costs were associated with pneumonia, whereas the highest admission costs were registered in patients with endocarditis (€15,991) and meningitis (€11,934). Mean admission costs increased significantly over the study period for pneumonia and bacteraemia and decreased for endocarditis. Conclusions The incidence of pneumococcal pneumonia and meningitis decreased over the study period after the introduction of vaccination in Spain. The advanced age of patients and presence of chronic comorbid conditions that are associated to in-hospital mortality must be taken into account when improving care protocols and upcoming vaccination plans.

Depression and Anxiety among Patients with Type II Diabetes Mellitus in Chitwan Medical College Teaching Hospital, Nepal.

The prevalence of depression and anxiety disorders is common among people with diabetes mellitus. Coexistence of diabetes and depression/anxiety increases the risk of diabetes complications and reduces the overall quality of life. Hence, this study aimed to assess the depression and anxiety among patients with type 2 diabetes mellitus in Chitwan. Descriptive survey was carried out among 296 purposively selected clinically diagnosed type 2 diabetes patients admitted in the Chitwan Medical College Teaching Hospital from 15th June 2018 to 17th September 2019. Patients were interviewed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorders-7 (GAD-7). Data were analyzed using descriptive and inferential statistics. Of 296 diabetic patients, 48.6% were 60 years and above, 59.5% female and 61.5% literate; their common occupation was agriculture (38.2%) followed by household work (26.4%). Nearly two-thirds (62.8%) of diabetes patients had other chronic comorbid conditions. Depression and anxiety were observed among 57.8% and 49.7% of diabetes patients, respectively. While observing the severity, 27.4%, 19.6%, 8.4%, and 2.4% of patients had mild, moderate, moderately severe, and severe depression, respectively. Likewise, 24.7%, 20.3%, and 4.7% of patients had mild, moderate, and severe anxiety, respectively. Current living status, educational status, medicine adherence, satisfaction toward current treatment, and history of mental illness in the family were found to be significant factors associated with the anxiety of patients with diabetes. Further, educational status, smoking habit, satisfaction towards current treatment, and history of diabetes in family were the factors associated with depression. Prevalence of depression and anxiety is high among admitted patients with diabetes mellitus, and many factors are associated with it. Hence, regular screening services are essential along with diabetes management plan for timely identification and treatment of the vulnerable groups in the healthcare centers.

Pilot randomized controlled trial Protocol: Life context-informed pre-visit planning to improve care plans for primary care patients with multiple chronic conditions including diabetes.

BackgroundMultimorbidity is common, and care is impacted by patient life context. Effective, efficient interventions to improve patient-centered outcomes such as perceived treatment burden are limited. There is a need for interventions that integrate patient contextual information into primary care encounters to improve such outcomes. Patient life context is a multitude of factors that influence a patient’s life and healthcare, including social determinants of health and broader elements such as family and work demands.MethodsThis pilot randomized controlled trial (RCT) protocol will compare standard pre-visit planning to context-informed pre-visit planning that incorporates the patient’s life context, for patients with diabetes plus other chronic comorbid conditions. Primary outcomes include measures of trial protocol and intervention feasibility and acceptability: physician study and visit perceived burden, patient satisfaction, and patient, physician and staff experience with the trial. Additional measurements of intervention impact include: initial estimates of effect size on patient treatment burden and other patient-oriented outcomes, change in glycemic control, and other intermediate medical outcomes.DiscussionThis intervention is novel as it collects patient life context information using a direct person-to-person approach, allows physicians to review the information prior to patient arrival at the clinic and, where appropriate, incorporate it when negotiating treatment plans, and is longitudinal, summarizing evolving contextual information over time. This pilot RCT has the potential to demonstrate trial protocol and intervention feasibility and acceptability, and estimate effect size on patient and provider outcomes, to inform for a future, definitive RCT.Trial Registration: This trial was registered at ClinicalTrials.gov prior to patient enrollment: NCT04568382

Impact of comorbidities on mortality in hospitalized patients with COVID-19: An experience from Iran.

BACKGROUND:COVID-19 pandemic has spread all over the world. However, information regarding clinical characteristics and prognostic factors is scarce. The aim of this study was to explore the impact of preexistent chronic comorbid conditions and multimorbidity on risk of mortality in patients with COVID-19.MATERIALS AND METHODS:We designed a retrospective, cross-sectional, observational, single-center study. Data were analyzed from all consecutive patients diagnosed with COVID-19 who admitted in a pandemic hospital affiliated with Tabriz University of Medical Sciences, Tabriz, Iran, from February 20, 2020, to September 25, 2020. The independent effects of preexistent conditions were evaluated using multivariate logistic regression model.RESULTS:A total of 2597 hospitalized patients with COVID-19 were included. At least one preexistent condition was observed in 36.5% of study population. Multivariate logistic regression analysis showed that older age, male sex, diabetes, cardiovascular disease, hypertension, cancer, chronic kidney diseases, liver diseases, and chronic obstructive pulmonary disease were associated with increased risk of mortality. In addition, the number of comorbidities was significantly associated with increased odds of mortality compared to no-comorbidity.CONCLUSION:The results of this study suggest that patients with comorbidities have an increased risk of in-hospital mortality following COVID-19 infection.

1041. Tenofovir alafenamide associated weight change in persons living with HIV

BackgroundPersons living with human immunodeficiency virus (PLWH) have a higher incidence of developing obesity, diabetes, and cardiovascular disease. TAF, a newer formulation of tenofovir, has favorable effects on renal function and bone mineral density compared to TDF. However, recent evidence suggests TAF may have a higher propensity for weight gain over TDF. The purpose of this study is to evaluate weight change in patient switched from TDF to TAF, keeping constant the other components of their antiretroviral therapy.MethodsThis retrospective observational cohort study evaluated adult PLWH who were followed for 12 months pre and post TDF to TAF therapy switch holding all other ART constant. Patients were excluded if not on TDF or TAF therapy for a minimum of 12 months, if there were additional changes to their ART, or if there was inadequate documentation of weight defined as less than 2 weight records pre and post TAF switch. Data collected included height, weight, HIV RNA, CD4 count, and presence of any current opportunistic infections or chronic comorbid conditions. The primary endpoint was change in weight after TAF switch. All variables were evaluated using linear mixed effect models over time.Results466 patient charts were reviewed and 55 patients met study criteria and were included in the analysis. The median age (SD) of patients included was 45.9 (12.6) years with most patients being male (67%) and black (73%). Patients had an HIV diagnoses for a mean (SD) of 10 (6.6) years with a mean (SD) CD4 count of 544 (246.8). Full baseline characteristics are recorded in Table 1. Notably, most patients had either an INSTI or PI in their baseline ART regimen (Table 1). The estimated overall marginal mean weight gain was 1.91 kg (95% CI 0.25-3.57, p=0.024). The estimated overall gain in BMI was 0.63 kg/m2 (95% CI 0.08-1.18). Significant predictors of weight gain included female gender (3.09, 95% CI 0.54 – 5.65) and use of both integrase and protease inhibitors at baseline (6.97 kg, 95% CI 3.02 – 10.92).ConclusionIn a predominantly black, male population, there was a statistically significant change in weight after a TAF switch.As this is the only data highlighting weight changes following tenofovir formulation change, more data is needed to elucidate the extent of weight-gain in patients on TAF-based regimens.Disclosures All Authors: No reported disclosures

1012. Efficacy, safety and tolerability of switching to bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in HIV-1 infected virologically-suppressed older adults in a real-world setting

BackgroundApproximately 50% of people living with HIV (PLWH) in the United States are ≥50 years old. Efforts are ongoing to identify antiretrovirals associated with fewer drug-drug interactions (DDIs) and long-term side effects in this group. Clinical trials of B/F/TAF demonstrated favorable efficacy and safety in older adults, however, data from real-word settings are needed to validate these results.MethodsThis retrospective analysis evaluated records from PLWH aged ≥ 50 years at the Orlando Immunology Center who were switched to B/F/TAF between 2/7/2018 and 5/31/2019. Eligible patients had baseline HIV-1 RNA< 50 copies/mL and were followed for 48 weeks post-switch. The primary endpoint was maintenance of HIV-1 RNA< 50 copies/mL at week 48. The impact of switching to B/F/TAF on DDIs, adverse events (AEs) and safety parameters were analyzed throughout the study.Results306 patients met inclusion criteria. 62 (20%) were female, 126 (41%) were non-white, median age was 58 years (range [r] 50-81), median duration of HIV infection was 19.5 years (r 2-40), median number of chronic co-morbid conditions was 5 (r 0-20), and median number of baseline concomitant medications was 4 (r 0-23). 159 (52%) patients were switched from regimens containing ritonavir or cobicistat. The most commonly documented reason for switch was simplification (Table 1). At Week 48, 287 (94%) patients maintained an HIV-1 RNA< 50 copies/ml and 19 (6%) had an HIV-1 RNA between 50-200 copies/mL (Figure 1). 1 patient discontinued due to lack of efficacy. A total of 123 potential DDIs were identified in 104 (34%) patients taking a boosting agent or rilpivirine at baseline (Table 2). At Week 48, there was a significant median decline in total cholesterol (15.5 mg/dL, 95% confidence interval [CI]: 9.5; 21.5), LDL cholesterol (9.5 mg/dL, 95% CI: 4; 15.5) and triglycerides (20 mg/dL, 95% CI: 9.5; 32.5), and median weight increased by 2.5 pounds (95% CI: 1.5; 3.5). Treatment-related AEs occurred in 33 (11%) patients (all Grade 1-2) and led to 7 (2%) discontinuations.Table 1-Baseline demographic and clinical characteristics Table 2-Avoidance of Drug-Drug Interactions (DDIs) following switch to B/F/TAF Figure 1-Subgroup analysis of virologic outcomes at Week 48 ConclusionIn this real-world cohort, switching to B/F/TAF was associated with maintenance of virologic control, improvement in lipid parameters, and avoidance of DDIs in a large proportion of patients. These data support use of B/F/TAF as a treatment option in older PLWH.Disclosures Charlotte-Paige M. Rolle, MD MPH, Gilead Sciences (Grant/Research Support, Scientific Research Study Investigator, Speaker’s Bureau)Janssen Infectious Disease (Grant/Research Support)ViiV Healthcare (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Speaker’s Bureau) Kiran Patel, PharmD, Gilead Sciences (Employee) Federico Hinestrosa, MD, AbbVie (Speaker’s Bureau)Gilead Sciences (Speaker’s Bureau)Merck (Speaker’s Bureau)Theratechnologies (Speaker’s Bureau) Edwin DeJesus, MD, Gilead Sciences (Advisor or Review Panel member)

Pain Characteristics, Psychosocial Wellbeing, and Sexual Wellbeing of Women Diagnosed With Provoked Vestibulodynia and a History of Sexual Abuse.

Provoked vestibulodynia (PVD) is a common chronic pain condition characterized by pain at the vulvar vestibule elicited by touch. Both PVD and sexual abuse lead to negative psychosocial and sexual consequences. However, little is known about the wellbeing of women with PVD and a history of sexual abuse. The aim of this study was to characterize a sample of women seeking treatment for PVD who have experienced sexual abuse. A total of 404 women diagnosed with PVD completed self-report questionnaires of PVD symptoms and psychosocial and sexual wellbeing before and after participating in a multidisciplinary PVD treatment program. History of sexual abuse was assessed via self-report, and women were dichotomized into groups. No significant differences were found on sociodemographic variables, baseline psychosocial or sexual functioning between women with and without a self-reported history of sexual abuse (n = 40 and n = 364, respectively). Significantly more women with a history of sexual abuse than without reported other comorbid chronic pain conditions and radiating PVD pain. History of sexual abuse did not affect improvements in sexual distress scores following multidisciplinary treatment for their PVD. Ten percent of women in our sample self-reported a history of sexual abuse, but the two groups did not differ significantly with respect to their baseline psychosocial or sexual functioning concerns, and both groups reported reductions in sexual distress following treatment for PVD. These findings indicate that a history of sexual abuse does not significantly affect the efficacy of multidisciplinary treatment approaches for PVD.

Management of type 2 diabetes with oral semaglutide: Practical guidance for pharmacists.

PurposeTo provide pharmacists with information on counseling patients with type 2 diabetes (T2D) receiving oral semaglutide.SummaryOral semaglutide, the first oral glucagon-like peptide 1 (GLP-1) receptor agonist (GLP-1RA), was approved for the treatment of adults with T2D by the US Food and Drug Administration in September 2019. Semaglutide has been coformulated with the absorption enhancer sodium N-(8-[2-hydroxybenzoyl] amino) caprylate to improve bioavailability of semaglutide following oral administration. Oral semaglutide has been shown to have efficacy and safety profiles similar to those of other GLP-1RAs. Many patients with T2D have a complex oral medication regimen to manage their T2D and concomitant chronic comorbid conditions. Therefore, it is important that patients follow the dose administration instructions closely: oral semaglutide should be taken on an empty stomach upon waking with a sip (≤120 mL) of plain water and at least 30 minutes before the first food, beverage, or other oral medications of the day. The most common adverse effects of oral semaglutide are gastrointestinal (typically nausea, diarrhea, and vomiting). It is important for pharmacists to counsel patients prescribed oral semaglutide about optimal oral dosing, why correct dosing conditions are necessary, expected therapeutic response, and effective strategies to mitigate potential gastrointestinal adverse events.ConclusionInformation and practical strategies provided by pharmacists may facilitate initiation and maintenance of oral semaglutide therapy and ensure that each patient achieves an optimal therapeutic response.

Identifying Patterns of Comorbidities with Cancers of the Colon and Rectum, as Related to age at Diagnosis

IntroductionAustralians have a high incidence of Colorectal cancer (CRC) and it is the second leading cause of cancer death. CRC patients experience more comorbid conditions such as diabetes and heart diseases than expected from population norms. It is anticipated that older patients with CRC will have even more comorbidities.&#x0D; ApproachData from South Australia Cancer Registry were linked with hospital inpatient separations (public and private) and Pharmaceutical Benefit Scheme data to acquire a detailed dataset of CRC patients in South Australia. We have investigated the prevalence of different comorbidities by age and subsite (colon vs rectal) in the 12 months period prior to CRC diagnosis using the chronic comorbid conditions used by Charlson and RX-risk indices.&#x0D; ResultsOf 11,656 CRCs diagnosed in 2003-2013, a significant higher prevalence of comorbidity presented in colon than rectal cancer patients using either indices. The most prevalent comorbidities for colon and rectal cancers respectively were: hypertension (25.9%, 22.0%), diabetes (17.3%, 15.6%) and gastric disease (11.4%, 12.4%). Common medications for colon and rectal cancers respectively were: hyperlipidaemia (38.4%, 33.7%), hypertension (38.0%, 31.7%) and gastroesophageal reflux diseases (36.2%, 26.8%). In younger patients (&lt;50 years) with colon and rectal cancer anaemia (9.1%) and diabetes (7.4%) were the most prevalent comorbidities and gastroesophageal reflux medications (17.1%) and opioids (14.5%) were used most frequently whereas, in older patients (&gt;79 years) hypertension (36.7%, 32.7%) was the most prevalent comorbid condition and hypertensive drugs (52.23%, 51,72%)were the most frequently used medication respectively.&#x0D; ConclusionAlthough often regarded as a single disease (CRC), colon and rectal cancers have different predisposing factors and clinical features. As expected, older patients have a higher prevalence of comorbid chronic diseases. We observe, however, that colon and rectal cancer have different comorbidity patterns by age.

Obesity Impacts Mortality and Rate of Revascularizations Among Patients With Acute Myocardial Infarction: An Analysis of the National Inpatient Sample.

BackgroundObesity is now a recognized chronic comorbid condition which is highly prevalent in the United States. Obesity poses several health risks, affecting multiple organ systems. The cardiovascular system is particularly affected by obesity including its role in atherosclerotic disease and hence myocardial infarction (MI) from atheromatous plaque events. However, multiple population-based studies have shown mixed outcomes in obese patients who have acute MI. This study aimed to determine if obesity paradoxically improved outcomes in patients with acute myocardial infarction (AMI) as well as compare outcomes of mild to moderately obese patients and morbidly obese patients to non-obese patients.Materials and methodsData was obtained from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. The study included adult patients with a principal discharge diagnosis of AMI. This group was divided into ST segment elevation myocardial infarction (STEMI) and non-ST segment myocardial infarction (NSTEMI). Obese patients were subdivided into two groups: mild-moderate obesity and morbid obesity. Primary outcome compared inpatient mortality. Secondary outcomes included rate of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), composite revascularization, mean length of hospitalization, total hospital charges, and rates of complications.ResultsIn patients with STEMI, mild to moderately obese patients had lower odds of mortality (aOR: 0.80, 95% CI: 0.715-0.906, p < 0.001) compared to non-obese patients. However, morbidly obese patients had higher odds of mortality (aOR: 1.26, 95% CI: 1.100-1.446, p < 0.001) compared to non-obese patients. Mild to moderately obese patients had higher odds of composite revascularization (aOR: 1.24, 95% CI: 1.158-1.334, p < 0.001), PCI (aOR: 1.08, 95% CI: 1.054-1.150, p = 0.014), and CABG (aOR: 1.46, 95% CI: 1.313-1.626, p < 0.001).ConclusionThe degree of obesity affects outcome of patients with AMI. Cardiovascular interventions during hospitalizations for AMI also varied with degree of obesity. This may have affected the outcome, especially among morbidly obese patients.

PSS17 Prevalence and Predictors of Multiple Chronic Conditions Among United States Older Adults with PAIN and Prescribed Opioids

Older adults typically have multiple chronic conditions, including pain, which is often managed with opioids. However, the relationship between personal characteristics and multiple chronic conditions in this population is unknown. This study sought to determine the prevalence and predictors of having ≥5 comorbid chronic conditions among older United States (US) adults with pain who use opioids. This retrospective, cross-sectional Medical Expenditure Panel Survey (MEPS) study included subjects who were aged ≥50 years, reported having pain in the past four weeks, and received a prescription for an opioid medication in 2017. The complex MEPS study survey design was accounted for to obtain national estimates. The outcome variable was ≥5 (vs <5) comorbid chronic conditions. Predictors of multiple comorbid chronic conditions were assessed using hierarchical logistic regression models and an a priori alpha level of 0.05. The weighted population was 14,050,810 US older adults with pain who used opioids, of which 9,592,237 (68.3%, 95% confidence interval [CI]=65.1%-71.5%) had ≥5 comorbid chronic conditions. Predictors significantly associated with ≥5 comorbid chronic conditions included: age 50-64 versus ≥65 years (adjusted odds ratio [AOR]=0.433, 95% CI=0.300, 0.624); male versus female gender (AOR=1.603, 95% CI=1.129, 2.278); Hispanic versus non-Hispanic ethnicity (AOR=0.458, 95% CI=0.273, 0.771); employed versus unemployed (AOR=0.605, 95% CI=0.382, 0.960); <200% federal poverty level vs >200% poverty level (AOR=1.672, 95% CI=1.164, 2.403); any limitations versus no limitations (AOR=3.290, 95% CI=2.144, 5.050); excellent/very good (AOR=0.374, 95% CI=0.230, 0.608) or good (AOR=0.670, 95% CI=0.450, 0.997) versus fair/poor physical health; and frequent versus infrequent exercise (AOR=0.676, 95% CI=0.491, 0.931). Among the 14 million US older adults with pain who used opioids in 2017, approximately 9.5 million had ≥5 comorbid chronic conditions. The characteristics that predicted the presence of multiple comorbid chronic conditions may be useful for health care professionals and patients when assessing their approach to pain management.