Expensive Care Research Articles

On the Strategies and Efficiency of Care and Support Systems for Elderly Across Cantons in Switzerland

The Swiss Federal Council has formulated a policy requiring each canton to establish housing conducive to independent living during old age. Maintaining the independence of older adults at home rather than transitioning to more expensive institutional care has gained traction. This study investigates the heterogeneity of strategies arising from the autonomy granted to each canton. Using mandatory statistics from the Swiss Federal Statistical Office for 2020 on 1550 institutions for the elderly and 2546 at-home care providers, we rank the 26 cantons by permanent and temporary care and support, distinguishing between at-home and institutional care. We use univariate regressions to explain differences and perform efficiency analyses of the respective systems. We find that the French- and Italian-speaking cantons prioritise at-home care, while the German-speaking regions rely more on institutional care. The analyses reveal an inefficient stationary approach in German-speaking cantons, which often places elderly individuals with minimal care needs in institutions. Conversely, with an ambulatory approach favouring independence, cantons like Vaud and Valais prioritize counselling and at-home services, deferring entry into institutions and allowing for short convalescence stays. Our findings are relevant for governmental infrastructure planning and the property owners, investors, and property managers involved in senior housing decisions.

Healthcare Access and Financing: A Legal and Public Health Perspective

The welfare provisions of the current Constitution centre on healthcare. The Indian Constitution's Article 42 declares that the state has an obligation to take all reasonable steps to promote public health. Additionally, Article 47 of the Indian Constitution, another article containing Directive Principles of State Policy, mandates that the state carry out its primary duties to improve public health by raising the standard of living, improving nutrition, and improving public health. In particular, the state must work to outlaw the use of drugs and alcohol, unless prescribed, as these substances are harmful to health. It follows that welfare regulations clearly place an obligation on the state to increase its assistance in promoting the health of those individuals who are unable to pay for the expensive medical care needed to treat their illnesses. In light of the urgency and importance of the issue, the World Health Organisation designated Universal Health Coverage (UHC) as its top goal. Ensuring that everyone has access to necessary health services of adequate quality and is shielded from the financial burden of medical expenses is the goal of universal health coverage. In underdeveloped nations, financial security against medical expenses is just as important as access to healthcare.

First results of laser treatment in our pediatric burn patients

Objectives: This study aimed to share the first results of the laser application we started using in our center to treat hypertrophic scars formed after burns. Patients and methods: The retrospective study was conducted with 10 pediatric patients (5 males, 5 females; median age: 3.5 years; range, 30 month to 10 years) treated for post-burn hypertrophic scars between January 2023 and July 2023. Burn patients to whom we applied Nd:YAG (neodymium:yttrium aluminum garnet) laser due to complaints such as contracture, hypertrophic scar, and itching were evaluated. Of all patients who underwent laser application, some received intralesional steroid application during the same session. The patient's age, sex, burn agent, burn percentage, scar areas, number of sessions, post-laser complaints, findings, the patient scar assessment scale (PSAS), and the observer scar assessment scale (OSAS) were evaluated. Results: The burn agent was two flame burns and eight scald burns. A graft was not applied in four patients, and a graft was used in six patients. The time between the burn dates and laser application ranged between seven months and eight years. One patient underwent four laser sessions, one patient had three laser sessions, and the other patients underwent one session. It was observed in the controls that after laser application, the itching decreased significantly, the hypertrophic scar softened, and its color faded. The PSAS and OSAS scores were found to be statistically significantly reduced (p< 0.01). Conclusion: In the treatment of post-burn hypertrophic scars with Nd:YAG laser treatment, the hypertrophic scar softens, its color fades, itching decreases significantly, and there is a decrease in contracture. Treatment satisfaction of patients and parents had a positive psychological impact on the family. Furthermore, laser therapy can reduce the cost of expensive post-burn care. The increasing use of laser applications also reveals the need for standardization.

LDCT lung cancer screening implementation in a Veterans Affairs hospital: A quality initiative.

e23238 Background: Lung cancer is the number one cause of cancer related deaths worldwide. United States Preventive Services Task Force (USPSTF) recommends annual Lung Cancer Screening (LCS) with Low Dose Computerized Tomography (LDCT) for adults who are current smokers aged 50 to 80 years with at least 20 pack year smoking history or have quit smoking within the past 15 years. Although LCS is a national initiative for Veteran Affairs (VA) Hospitals, there are several barriers in practice. Methods: The LCS program was established with a dedicated coordinator to provide better access to high-quality in-house screening, while reducing the dependance on expensive community care services and referrals. Smoking history in Tobacco Pack Years (TPY) is updated during a Primary Care Physician (PCP) visit, which triggers a clinical reminder in the electronic medical record for LCS. The LCS coordinator would then receive a consult. After shared decision-making with the patient, physician and coordinator, the patients are scheduled for LDCT. If the results are Lung-RADS 1 (negative), 2 or 3 (benign appearing nodules) the patients are notified of the findings and provided with subsequent follow ups. All Lung RADS 4 (suspicious findings) are discussed in the lung tumor board, which includes radiologist, oncologist, pulmonologist, pathologist, cardio-thoracic surgeon, and fellows in training. The committee determines the follow-up scan interval and/or additional investigations. Results: The performance of our LCS Program from June 2022 to January 2024 was reviewed. 5941 patients were assessed for TPY, of those 1127 patients were eligible for LCS scans and 1032 (93.3%) were enrolled into the LCS Program. 951 LDCT scans have been conducted thus far, this includes 598 annual initial screenings, the remaining are follow ups. 57 patients (6.81%) had Lung-RADS 3 findings and are undergoing nodule tracking. 16 patients (1.91%) required diagnostic work-up which includes a PET scan or biopsy. 14 patients (1.67%) have been diagnosed with cancer. Conclusions: Our LDCT Program showed a high acceptance rate of 93.3%, much of which can be attributed to the multiple layers of screening and shared decision-making processes. Patients received three phone calls and a letter as a reminder of their LDCT appointments. Our radiology department has four dedicated slots for LDCT screening each day which allows for further compliance. TPY documentation was identified as a limiting factor in this process. The LCS coordinator verified the TPY history with the patients which helped overcome this shortcoming. Overall a multidisciplinary team approach contributed to the success of our program.

Assessment of health perceptions, use of health services and traditional health practices of Afghan immigrants in Türkiye.

Immigration, as a social determinant of health, encompasses several social and economic transformations. Neglecting to adequately address this issue could potentially worsen pre-existing challenges within health systems and in the management of migration. In the present study, we aim to evaluate the health perceptions, traditional health practices and use of health services of Afghan immigrants. We enrolled 1597 Afghan immigrants over 18 years old in the descriptive cross-sectional research. The mean age of the immigrants was 49.19 ± 1.6 years. The smallest number of points that can be achieved on the health perception scale is 15, while the greatest number is 75. We found that the health perception scale average score is 37.61 ± 7.32. Some factors, such as age 65 and over, female gender, postgraduate education level, good social insurance and economic status, being a public officer, not having any infectious diseases, and having a good Turkish level, have positively affected the health perception levels (p < 0.05). Moreover, we observed that cultural differences, expensive health care, a lack of social insurance, fear and anxiety, lack of language skills, waiting times and traditional health practices were the most common barriers to accessing healthcare services. Considering these issues in the health system, identifying the factors that negatively affect the perception of health and related to the use of health services can help immigrants increase their use of health services and improve their health.

BRIDGING THE GAP BETWEEN PRIMARY AND SECONDARY CARE POST-HIP FRACTURE WITH A NOVEL PATIENT ADVOCATE ROLE

Within an ageing population, the morbidity and mortality burden of neck of femur fractures will only worsen. Financially incentivising acute Trusts via the Best Practice Tariff for inpatient care has yielded good results(1,2,3,4) but post-discharge care is still variable. Most importantly, restoring patients to their pre-fracture mobility is key to their quality of life(5,6) and reducing both readmissions to hospital(7,8) and expensive local authority residential care. Unfortunately, physiotherapist vacancies are in their thousands(9,10) leading to waiting times of around three months once discharged(11).In 2019, the Royal Derby Hospital created a novel Hip Fracture Patient Advocate (HFPA) to observe those who have fallen through gaps in community services. It involves monitoring patients’ progression, signposting to appropriate services, flagging issues to the responsible consultant and assisting in physical mobilisation.A retrospective review examined data from patients discharged to their own homes. This included demographics, residential status and mobility, both pre-fracture and at 120 days post-fracture. Mobility was classified into five categories, in line with the national hip fracture database.In 2018, of 238 patients, 41.2% returned to their baseline or increased mobility, and, after the introduction of the HFPA in 2019, this figure increased to 48.2%.In one year, there was a 7% increase in patients recovering their baseline mobility. This is a cost-effective intervention that can successfully improve mobility, leading to improved long-term outcomes. This includes the potential to reduce acute readmissions and the need for residential care, appealing to Integrated Care Boards. It also bridges the gap to primary care to optimise medical management and after further development, could be financially-incentivised via the Best Practice Tariff. Rather than thinking more expensive clinicians are required, this study proposes that a HFPA can garner better outcomes for both the patient and the wider system.

Does Participating in New Rural Cooperative Medical Insurance Change Catastrophic Health Expenditure? Evidence from the China Household Income Project.

A primary goal of the New Rural Cooperative Medical Insurance (NRCMI) is to provide financial protection against health care costs and alleviate the financial burdens of rural residents in China. This article examines whether NRCMI participation impacted the incidence of catastrophic health expenditure (CHE) among middle-aged and older adults (45 years old and above). The analysis utilized data from the 2007 China Household Income Project survey in rural areas and an instrumental variable estimation method in Anhui and Sichuan provinces, which exhibited heterogeneity in the NRCMI implementation schedule. The results show that NRCMI participation was not associated with changes in the CHE incidence among families. The finding is consistent with the prior literature using quasi-experimental study designs. This study provides empirical evidence for policymakers, highlighting that the impact of NRCMI participation on financial protections is limited despite its extensive population coverage. The limited effects are probably due to the low reimbursement rate and increased utilization of expensive health care services.

Effect of lithium on chemotherapy-induced neutropenia in Egyptian breast cancer patients; a prospective clinical study.

Myelosuppressive chemotherapy-induced neutropenia (CIN) remains a major limitation of cancer treatment efficacy, necessitating very expensive supportive care. Lithium carbonate, an inexpensive drug, can increase the number of neutrophils, possibly providing an efficacious and cost-effective alternative for treating CIN. The aim of this study was to determine whether lithium therapy can attenuate chemotherapy-induced neutropenia and leukopenia in breast cancer patients. A total of 50 breast cancer patients were enrolled in this prospective, interventional, randomized, controlled, and single-blind study. The patients were divided into two groups: a control group (group 1, N = 25 patients) and a lithium-treated (treatment) group (group 2, N = 25 patients). Group 1 patients were further subclassified into a non-neutropenic control group (N = 16) and a neutropenic control (N = 9) based on the subsequent development of severe neutropenia, or not. The control group received 4 cycles of doxorubicin or epirubicin plus cyclophosphamide followed by 2 cycles of paclitaxel. The treatment group received the same regimen as the control group as well as oral lithium carbonate throughout the chemotherapy cycles. The results showed that the absolute neutrophil count (ANC) was increased in the lithium-treated group, while it was markedly reduced in both the non-neutropenic and neutropenic control groups (by 55.56% and 65.42% post-4 chemotherapy cycles, and by 19.57% and 39.90% post-6 cycles, respectively). The same pattern of alterations was observed for the total white blood cell count in both the control and treatment groups. In addition, the incidence and period prevalence were greatly reduced in the lithium-treated group compared to non-neutropenic and neutropenic control groups. Lithium therapy ameliorated chemotherapy-induced leukopenia and neutropenia in breast cancer patients. This may provide a new strategy for cost-effective treatment of CIN, particularly in Egyptian cancer patients.

Health-care Utilisation among Elderly People with Chronic Medical Conditions in a Secondary Health-care Center, Southwestern Nigeria

Abstract Background: The elderly population of the world is projected to continue to increase. There is an anticipated increase in the utilisation of health-care services due to chronic diseases and other impairments with resulting pressure on health systems. Aims: This study aimed to determine the health-care utilisation of elderly patients with chronic medical diseases attending a secondary health facility in southwestern Nigeria. Materials and Methods A structured questionnaire was administered to gather the data from 300 older people by random sampling during follow-up care for those receiving care for more than 6 months following a diagnosis of a chronic disease. SPSS software version 26 was used for the data analysis, and the results are presented in the tables. The Chi-square test was applied to test for associations between the categorical variables, and a logistic regression model was used to rule out confounders, while P &lt; 0.05 was considered to indicate statistical significance. Results: The mean age (standard deviation) in the study was 68.26 (7.01) years and 58.3% were females. The average number of routine clinic visits was 4.12, whereas 20.7% had emergency room visits, 6.6% were referred to specialists, and 33.3% had laboratory investigations. After logistic regression was applied, living conditions, average monthly income, and treatment for diabetes were found to be significant factors for the utilisation of care. Conclusion: The provision of rich social support, improving economic empowerment, and performing screening and timely management for diabetes will improve preventive care while reducing the use of expensive and specialised care for older people.

Making a Case for Whole Person Health.

Background: Our conventional approach to health care tends to separate patients' health by body system, treating each independently and "efficiently"-e.g., minimal time with a provider, reliance on medications, and little investment to support behavioral and lifestyle improvements. Meanwhile, the United States has the most expensive health care in the world, with some of the worse outcomes. Purpose In this paper, we make the case for transforming health care from a disease-centric approach to a "whole person" model. Research Design: We provide detailed health and health care utilization assumptions for a hypothetical patient, Mrs. M, over her life from age 40 to 80 years under 2 care scenarios: the continuation of conventional care (Version A) and a whole person care approach (Version B). Analysis We developed a set of health care utilization assumptions for each scenario, applied 2023 U.S. dollar (USD) resource prices, and estimated cumulative total health care costs. The price and the health care utilization assumptions for the conventional care scenario were validated using Medical Expenditures Panel Survey (MEPS) data. Results: At age 80, with conventional care, we find Mrs. M increasingly frail and living in a skilled nursing facility, with total cumulative health care costs of $353,155. With whole person care, we find her active and generally healthy at age 80, with total cumulative health care costs of $52,425. Conclusions: Although based on an "imagined" case, the 2 versions of Mrs. M's history illustrate how an investment beginning in early middle age to support a healthy diet, physical activity, and stress management can plausibly lead to improved health and well-being, as well as reduced health care spending.

Types of Empowerments on Improving Hypertension among Elderly: A Systematic Review

Introduction: Hypertension is a cardiovascular disease, often referred to as the silent killer disease, that mostly affects the elderly. Changes in body condition and unhealthy lifestyles cause hypertension in the elderly. Hypertension is basically a cause of high mortality and impacts expensive care for the elderly. The caregiver's lack of ability is one of the triggers for the severity of hypertension. The caregiver plays a crucial role in helping elderly people with hypertension become independent. Research on the empowerment of caregivers of elderly hypertensives is very diverse, but research on the most effective empowerment for caregivers is limited. Objective: This study aims to investigate the type of empowerment that improves hypertension in the elderly. Methods: The online databases include Science Direct, ProQuest, PubMed, Sage, Ebscohost, and Google Scholar. Articles were reviewed from 2018 to 2022. Protocol and evaluation of literature review using the PRISMA checklist and the Joanna Briggs Institute Guidelines. Results: A total of 15 articles define the types of empowerments, comprising 6 types of such as family empowerment (4 articles), social support (4 articles), adaptation (2 articles), education (3 articles), dyadic partnership (1 article), and multidisciplinary (1 article). The development of a caregiver empowerment model is expected to increase the ability to care for the elderly and have an impact on the self-management of hypertension. Conclusions: Empowering caregivers for elderly people with hypertension is an important step in ensuring that elderly people receive optimal care and are able to better manage their hypertension condition. The most common were family empowerment and social support.

A panel vector autoregression analysis for the dynamics of medical and long-term care expenditures.

Although medical and long-term care expenditures for older adults are closely related, providing rigorous statistical analysis for their dynamic relationship is challenging. In this research, we propose a novel approach using the panel vector autoregression model to reveal the realized patterns of the interdependence. As an empirical application, we analyze monthly panel data on individuals in a city of Japan, where social insurance covers many formal services for long-term care. Our estimation results indicate the existence of intertemporal transition from expensive acute medical care to reasonable at-home medical care, then to at-home long-term care. Under this context, the enhancement of formal long-term care sector in Japan might have played an important role in the suppression of the total care cost in spite for its rapid aging over the past 2decades. Additionally, we find that daycare plays multiple roles in Japanese long-term care, such as respite and rehabilitation, but there is no considerable transition from outpatient rehabilitation to daycare in the long-term care sector.

Computing the Cost of Care per Patient per Day for Patients With Metastatic Neuroendocrine Neoplasms.

Patients with well-differentiated, low-grade metastatic neuroendocrine neoplasms (NENs) usually have a long median survival and require complex, expensive care over many years at multidisciplinary centers. The cost burden for patients and institutions serves as a barrier to care. Understanding the drivers of these costs and whether intense monitoring adds value will help to optimize value-based care. We adapted the cost of care per patient per day (CCPD) validated methodology to measure cost while accounting for varying follow-up duration. We queried the Stanford NEN Database, which aggregates data from the electronic health record and other electronic sources, to study patients with metastatic NENs receiving regular care at Stanford. Current Procedural Terminology codes for services incurred during the monitoring period for each patient were mapped to the corresponding cost conversion factor and date in the Medicare fee schedule. Two hundred two patients between 2010 and 2017 were studied with a mean CCPD of $119.11 in US dollars (USD); NEN-specific systemic therapy made up 55% of this cost. Somatostatin analogs were the costliest systemic therapy. Systemic therapy was the driver of cost differences among patients with various primary tumor types, stage of disease, tumor differentiation and grade, and functional hormone status. Patients in the most expensive CCPD group did not have a significant survival benefit (P = .66). The CCPD methodology was effective in studying cancer care value in NENs. Systemic therapy, specifically somatostatin analogs, was the primary driver of cost, and intense monitoring and higher-cost care did not improve survival outcomes.

Economic burden of transitions to later stages of Alzheimer’s disease in Europe: elevating the sense of urgency to treat

AbstractBackgroundAlzheimer’s disease (AD) significantly impacts individuals, families, and society worldwide. In Europe, it affects approximately 10 million people, leading to considerable healthcare costs, caregiver burden, and reduced productivity.1 It is crucial to slow down AD progression in order to alleviate the rising burden of the disease.MethodTwo targeted reviews were conducted, one on the prevalence of individuals with biomarker‐confirmed AD pathology and the other on the costs associated with AD by disease stage and care setting. The most recent prevalence1,2,3,4,5,6,7,8 and cost9,10,11,12,13,14,15,16,17,18 data were identified for selected countries, including the UK, France, Germany, Italy, Spain, Sweden, Netherlands, Finland, Switzerland, Estonia, and the Czech Republic. Regression‐based or linear extrapolation methods were applied to fill the existing data gaps where appropriate. All costs were converted to USD and adjusted for inflation to reflect 2022 values.ResultThe national costs associated with annual transitions across all AD stages were estimated to be ($11.4bn) in Germany, followed by France ($6.2bn), UK ($5.2bn), Spain ($3.7bn), Italy ($3.2bn), Switzerland ($1.9bn), Sweden ($1.4bn), Netherlands ($1.07bn), Finland ($0.8bn), Czech Republic ($0.7bn), and Estonia ($0.03bn). Early‐stage progression, with the largest number of individuals transitioning from mild cognitive impairment (MCI) to mild AD, accounted for more than half of the total transitioning costs in the UK, Spain, Finland, Netherlands, Czech Republic, and Estonia. However, the highest cost burden varied across the countries. In Germany, Italy, and Switzerland, similar to previous estimates for the US,19 the highest burden was associated with late‐stage progression from moderate to severe dementia, despite the relatively lower number of such transitions. This is likely due to the more expensive institutional care in these countries. Our findings further suggest that including the economic value of uncompensated caregiving substantially increases the total costs while leading to greater variability in estimates. The interpretation of these results should take into account data limitations and the assumptions made in the analysis.ConclusionThe economic burden of AD increases as disease progresses. Total costs and the underlying components vary across health systems and regions. Nevertheless, universally, any treatment that slows down the disease progression could result in substantial costs savings.

Comparing super-utilizers and lower-utilizers among commercial- and Medicare-insured adults with sickle cell disease

AbstractSickle cell disease (SCD) is a rare but costly condition in the United States. Super-utilizers have been defined as a subset of the population with high health care encounters or expenditures. Although super-utilizers have been described in other disease states, little is known about super-utilizers among adults with SCD. This study aimed to characterize the differences in expenditures, overall health care encounters, and pain episode encounters between super-utilizers (top 10% expenditures) and lower-utilizers with SCD (high, top 10%-24.9%; moderate, 25%-49.9%; and low, bottom 50% expenditures). A retrospective longitudinal cohort of adults with SCD were identified using validated algorithms in MarketScan and Medicare claim databases from 2016 to 2020. Encounters and expenditures were analyzed from inpatient, outpatient, and emergency department settings. Differences in encounters and expenditures between lower-utilizers and super-utilizers were compared using logistic regression. Among super-utilizers, differences in encounters and expenditures were compared according to incidences of pain episode encounters. The study population included 5666 patients with commercial insurance and 8600 with Medicare. Adjusted total annual health care expenditure was 43.46 times higher for super-utilizers than for low-utilizers among commercial-insured and 13.37 times higher in Medicare-insured patients. Among super-utilizers, there were patients with few pain episode encounters who had higher outpatient expenditures than patients with a high number of pain episode encounters. Our findings demonstrate the contribution of expensive outpatient care among SCD super-utilizers, in which analyses of high expenditure have largely focused on short-term care. Future studies are needed to better understand super-utilizers in the SCD population to inform the effective use of preventive interventions and/or curative therapies.

Validating and Improving Adjusted Clinical Group's Future Hospitalization and High-Cost Prediction Models for Dutch Primary Care.

The rise in health care costs, caused by older and more complex patient populations, requires Population Health Management approaches including risk stratification. With risk stratification, patients are assigned individual risk scores based on medical records. These patient stratifications focus on future high costs and expensive care utilization such as hospitalization, for which different models exist. With this study, the research team validated the accuracy of risk prediction scores for future hospitalization and high health care costs, calculated by the Adjusted Clinical Group (ACG)'s risk stratification models, using Dutch primary health care data registries. In addition, they aimed to adjust the US-based predictive models for Dutch primary care. The statistical validity of the existing models was assessed. In addition, the underlying prediction models were trained on 95,262 patients' data from de Zoetermeer region and externally validated on data of 48,780 patients from Zeist, Nijkerk, and Urk. Information on age, sex, number of general practitioner visits, International Classification of Primary Care coded information on the diagnosis and Anatomical Therapeutic Chemical Classification coded information on the prescribed medications, were incorporated in the model. C-statistics were used to validate the discriminatory ability of the models. Calibrating ability was assessed by visual inspection of calibration plots. Adjustment of the hospitalization model based on Dutch data improved C-statistics from 0.69 to 0.75, whereas adjustment of the high-cost model improved C-statistics from 0.78 to 0.85, indicating good discrimination of the models. The models also showed good calibration. In conclusion, the local adjustments of the ACG prediction models show great potential for use in Dutch primary care.

Molecular Docking, Dynamics Simulation, And in Silico DFT Studies Of Bromo [1,4] Benzodiazepine Derivatives Are Efficient Ways to Prevent Skin Cancer

Studies have revealed that the most common kind of cancer in the world is skin cancer. Unrepaired deoxyribonucleic acid (DNA) in skin cells can cause genetic abnormalities or mutations that lead to skin cancer. Early detection is crucial because skin cancer is more treatable in its early stages and tends to gradually spread to other areas of the body. Early detection of signs of skin cancer is essential due to the high mortality, increasing morbidity and expensive medical care of the disease. The present study used ligand and structure-based analysis to calculate the interaction between bromo [1,4] benzodiazepine derivatives and 4,5 Diaryl Isoxazole Hsp90 Chaperone Inhibitors: Potential Therapeutic Agents for Cancer. Qikprop revealed that the structures of several antiviral drugs were identical to those of bromo[1,4] benzodiazepine derivatives (1a-1j). bromo [1,4] benzodiazepine derivatives were employed in an in silicodocking experiment, DFT calculations and simulation techniques on skin cancer with PDB ID 2VCI, using Schrodinger Maestro 12.4. Each ligand's interaction was studied, and the potential imperative energy was calculated. In summary, a high potency against skin cancer as observed for the derivative of bromo [1,4] benzodiazepine derivatives with the best binding energy.

Pre-morbid frailty is associated with poor outcome after thrombolysis in older patients with ST-elevation Myocardial Infarction

Introduction: In recent years, the association of frailty has been established with a poor outcome after percutaneous intervention following an acute cardiovascular event. However, a larger proportion of the world population is unable to access the prohibitively expensive tertiary cardiac care and receives the more readily available, affordable and acceptable thrombolytic therapy in emergency situations. The current study was designed to explore the association of pre-morbid frailty with immediate and short-term outcome of thrombolysis in older subjects presenting with ST-elevation myocardial infarction to our hospital. Methods: This was an observational prospective cohort study completed between 2015 and 2017 at a tertiary care teaching hospital in Delhi. Patients older than 60 years who presented to the hospital with ST-elevation myocardial infarction and underwent successful thrombolysis were included for the study. Complications such as bleeding, reperfusion reactions and allergic reactions were recorded whenever these were observed. In addition, complications such as re-infarction, stroke, cardiac arrest, cardiogenic shock and death were also recorded. In addition, a short-term outcome in terms of discharge, death, recovery was noted. A pre-morbid frailty score was historically computed with inputs from the patients and their primary caretakers using a deficit count approach on a pre-defined list of fifty self-reported deficits. The descriptive statistical analysis comprised of calculating means (standard deviations) and proportions (frequencies and percentages). The association of premorbid deficit score with thrombolysis success and other variables was tested by calculating mean ranks, and Mann Whitney U test was used as a statistical test of significance. Spearman correlation coefficient was used to determine the association between frailty and complications and morbidity and mortality indicators. Univariable logistic regression models were used to evaluate independent variables associated with outcome of thrombolysis to further explore the association between frailty and outcome. Independent variables found significantly associated with poor outcome were entered into a multivariable logistic regression model (forward) in addition to those considered scientifically relevant. Results: In the present study, we found a significant association between a higher pre-morbid frailty status assessed by an interview-based deficit count score and poorer outcome of thrombolysis. Every unit increment in the frailty deficit count score on a scale of 50 points increased the odds of failed thrombolysis by 1.14 times. Frailty was also associated with an increased risk of reperfusion arrhythmias and cardiac arrest following thrombolysis. Additionally, we noted that higher the deficit score, lesser the resolution of ST segment on ECG, 90 minutes following thrombolysis. Conclusions: Our study indicates that frailty determined by a premorbid count of health deficits is associated with the outcome of thrombolysis following myocardial infarction in older patients. The patients with greater count of deficits have a higher chance of failure. Our findings will help informed decision-making while managing older patients presenting with myocardial infarction and in-turn improve morbidity and mortality.

Which multimorbidity clusters in hypertensive patients are associated with longer hospital stays?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The number of people with hypertension will increase by 15-20% by 2025. Research shows that up to two thirds of hypertensive patients have other comorbidities. Multimorbidity defined as the coexistence of two or more diseases in the same person, is now a common phenomenon. Patients with multimorbidity have poorer health outcomes and are more likely to use unscheduled hospital healthcare. By identifying hypertensive clusters, their need for hospital care and the cost of care can be determined. Patient profiling has the potential to improve treatment outcomes and increase the efficiency of care. Purpose Identification and characterization of multimorbidity clusters in hypertensive patients and assessment of which of them were responsible for longer hospitalization. Material and Methods Data from 489 patients admitted to the cardiology department with hypertension as the main diagnosis over three years was used for the analysis. 163 patients (81 women, 82 men, mean age 63.93 ± 11.49) had multiple conditions (≥ 2 conditions). Patient profiles for each group were described by age, gender, hypertension grade and length of hospital stay. Partitioning Around Medoids method was used to divide patients into clusters. Dissimilarity between patients was measured with Gower distance. Number of clusters was determined using Silhouette method. Significance level for all statistical tests was set to 0.05. Results Hypertensive patients reported comorbidities such as heart failure (14%), diabetes (28%), chronic kidney disease (14%), stroke (12%), acute coronary syndrome (8%), obesity (37%). There were 12 clusters for the study group: (1) without comorbidities, (2) obesity only, (3) obesity and diabetes mellitus (DM),(4) heart failure (HF) and chronic kidney disease (CKD),(5) DM,(6) acute coronary syndrome (ACS),(7) obesity, stroke, and DM,(8) CKD and other diseases without HF,(9) obesity and ACS, (10) stroke, (11) HF and obesity,(12) DM, HF and often obesity. It was noted that ACS patients significantly older than patients without comorbidities and from patients in clusters 2, 3, 7, 8 and 10. In addition, patients with DM only and patients with DM, HF and obesity were significantly older than patients who were only obese. Hospitalization time was significantly longer in patients with HF than in patients from clusters 1, 2, 5, 7, 10. Significantly longer in patients with CKD but without HF than in clusters 1, 5, 7. Significantly longer in patients with HF and obesity than in clusters 1 and 7. Significantly longer in patients with obesity and DM and in patients with DM, HF and often obesity than in patients without comorbidities. Conclusions Comorbidities affect the length of hospitalization of patients with hypertension. Comorbidities such as HF, CKD, DM and obesity will prolong the hospitalization of hypertensive patients. Clinical profiles of patients allow forecasting the need for longer and more expensive medical care.

EFFECT OF NOSTRIL BREATHING ON BLOOD PRESSURE IN HYPERTENSION PATIENTS

Hypertension other resulted number death which tall also impact on expensive treatment and care that must be borne by the sufferer. It should be noted that hypertension has an impact on decline quality of human life. If you have high blood pressure however no quick done treatment and control in a manner regular then what happens is that it will have an impact in even serious cases death. Nostril breathing technique is breathing by closing one hole nose in a manner alternate. Nostrils breathing tehnique own benefit that is can strengthen whole system respiratory, overcome stress, lower pressure blood. The purpose of this study was to identify the effect of nostril breathing on blood pressure. This type of research is a quasy experiment using the pre and posttest method without a control group design. The sample in this study was 20 people using a purposive sampling technique. The aspect to be measured in this study is blood pressure. The data obtained from the measurement results twice, namely blood pressure before and after the intervention was given. Statistical analysis used in this study is to use paired t-test. The results showed that the average blood pressure analysis before the nostril breathing intervention was given was (mean : 150.50) , and the average value after the intervention was given (mean : 139.00). The results of the analysis of the effect of nostril breathing on blood pressure using the paired t-test obtained a value of p = 0.000 (p &lt;0.05 ) . Data analysis showed that there were significant differences between blood pressure before and after the intervention.