Economics of psychosocial factors in patients with cardiovascular disease

Influencing factors of hospitalization cost of hypertension patients in traditional Chinese medicine hospitals

Objectives

This study aimed to analyze the influencing factors of hospitalization cost of hypertensive patients in TCM (traditional Chinese medicine, TCM) hospitals, which can provide a scientific basis for hospitals to control the hospitalization cost of hypertension.

Methods

In this study, 3,595 hospitalized patients with a primary diagnosis of tertiary hypertension in Tianshui City Hospital of TCM, Gansu Province, China, from January 2017 to June 2022, were used as research subjects. Using univariate analysis to identify the relevant variables of hospitalization cost, followed by incorporating the statistically significant variables of univariate analysis as independent variables in multiple linear regression analysis, and establishing the path model based on the results of the multiple linear regression finally, to explore the factors influencing hospitalization cost comprehensively.

Results

The results showed that hospitalization cost of hypertension patients were mainly influenced by length of stay, age, admission pathways, payment methods of medical insurance, and visit times, with length of stay being the most critical factor.

Conclusion

The Chinese government should actively exert the characteristics and advantages of TCM in the treatment of chronic diseases such as hypertension, consistently optimize the treatment plans of TCM, effectively reduce the length of stay and steadily improve the health literacy level of patients, to alleviate the illnesses pain and reduce the economic burden of patients.

Impact of Mental Health Treatment on Outcomes in Patients With Heart Failure and Ischemic Heart Disease

BACKGROUND

There is conflicting evidence as to the impact of mental health treatment on outcomes in patients with heart disease. The aim of this study was to examine whether individuals who received mental health treatment for anxiety or depression after being hospitalized for ischemic disorders or heart failure had a reduced frequency of rehospitalizations, emergency department visits, or mortality compared with those who did not receive treatment.

METHODS AND RESULTS

A population-based, retrospective, cohort design was used to examine the association between psychotherapy or antidepressant medication prescription and health service utilization and mortality in patients with coronary artery disease or heart failure and comorbid anxiety or depression. Those receiving versus not receiving mental health treatment were compared based on the frequency of rehospitalization, emergency department visits, and mortality. The study sample included 1563 patients who had a mean age of 50.1 years. Individuals who received both forms of mental health treatment for anxiety or depression were 75% less likely to be rehospitalized, 74% less likely to have an emergency department visit, and 66% less likely to die from any cause.

CONCLUSIONS

Mental health treatment for anxiety or depression has a significant impact on outcomes in patients with cardiovascular disease consisting of reduced hospitalizations, emergency department visits, and in some conditions improved survival.

Goal-directed versus outcome-based financial incentives for smoking cessation among low-income, hospitalised patients: rationale and design of the Financial Incentives for Smoking Treatment II (FIESTA II) randomised controlled trial

INTRODUCTION

Smoking remains the leading preventable cause of death in the USA. Low utilisation of treatments for smoking cessation remains a major barrier for reducing smoking rates. Financial incentives represent an innovative approach to increasing use of therapies for smoking cessation. This paper will describe the rationale and design of the Financial Incentives for Smoking Treatment II (FIESTA II) study, a randomised controlled trial to evaluate the effectiveness and feasibility of goal-directed and outcome-based financial incentives to promote smoking cessation among hospitalised smokers.

METHODS AND ANALYSIS

We are recruiting adult participants who smoked tobacco in the 30 days prior to initial interview and are contemplating quitting smoking. These participants will come from two hospitals in underserved communities in New York City and Los Angeles. They will be randomised into one of three arms. The first arm consists of goal-directed financial incentives plus enhanced usual care, which includes hospital-directed information about quitting smoking, nicotine replacement therapy and referral to a Quitline. The second arm involves outcome-based financial incentives plus enhanced usual care. The third arm consists of enhanced usual care alone. Multiple phone interviews with the participants will be completed after randomisation to assess smoking cessation. Participants will earn $20 for each follow-up interview completed and $30 for each smoking cessation test completed. Those who are randomised to the financial incentive groups can earn an additional $700. The participants in the outcome-based group will receive payments solely for exhibiting cessation, whereas the participants in the goal-based group are also eligible for receiving payments after meeting milestones such as speaking with a helpline coach.

ETHICS

Human research protection committees at New York University School of Medicine and the University of California Los Angeles (UCLA) David Geffen School of Medicine granted ethics approval.Protocol number: IRB#19-000 084.

TRIAL REGISTRATION NUMBER

NCT03979885.

How to optimize the adherence to a guideline-directed medical therapy in the secondary prevention of cardiovascular diseases: a clinical consensus statement from the European Association of Preventive Cardiology

A key factor to successful secondary prevention of cardiovascular disease (CVD) is optimal patient adherence to treatment. However, unsatisfactory rates of adherence to treatment for CVD risk factors and CVD have been observed consistently over the last few decades. Hence, achieving optimal adherence to lifestyle measures and guideline-directed medical therapy in secondary prevention and rehabilitation is a great challenge to many healthcare professionals. Therefore, in this European Association of Preventive Cardiology clinical consensus document, a modern reappraisal of the adherence to optimal treatment is provided, together with simple, practical, and feasible suggestions to achieve this goal in the clinical setting, focusing on evidence-based concepts.

Evidence-Based Determination of Cut-Off Points for Increased Cardiac-Surgery Mortality Risk With EuroSCORE II and STS: The Best-Performing Risk Scoring Models in a Single-Centre Australian Population

OBJECTIVES

Risk scoring models (RSMs) are commonly used for estimation of postoperative-mortality risk in patients undergoing cardiac surgery, but their prediction accuracy may vary in different populations and clinical situations. The prognostic accuracies of some RSMs have not yet been fully evaluated in the Australian population. In this retrospective observational study, our aims were to assess the performance of four contemporary RSMs, to identify the best RSMs for prediction of postoperative-mortality in the single-centre cohort, and to determine a statistical threshold for classification of patients with increased or "higher" mortality risk.

METHODS

The study population included patients who underwent cardiac surgery at Liverpool Hospital between January 2013 and December 2014. Demographic information was collected, and mortality risks were estimated with the ES2 (EuroSCORE II), STS (Society of Thoracic Surgeons Score), AS (AusSCORE total) and ASMR (AusSCORE multi-risk) RSMs. (Additive EuroSCORE) (AES) and LES (logistic EuroSCORE) were included for historical interest. Discrimination, the ability to stratify patients between mortality and no mortality outcomes, and calibration, the comparison of risk score estimated and observed outcome in the population, were evaluated for each RSM, to determine their predictive accuracy in the study population. Discrimination was assessed by the AUC (area under the receiver operating characteristic curve), and acceptable calibration by the p-value greater than 0.05 for the Hosmer-Lemeshow (H-L) test. The best AUCs in contempory models were compared using the DeLong test. For ES2 and STS risk scores, cut-off points, or thresholds, for patients at increased risk of mortality were derived using Youden's J-statistics, calculated from sensitivity and specificity of models in predicting mortality.

RESULTS

From a total study population of 898 patients, 738 had scores for all six RSMs. The three EuroSCORE risk models and Youden's J-statistics analysis included the total population. Of the models in contemporary use, ES2 had higher discrimination (AUC=0.850) in this population than ASMR (AUC=0.767, p=0.024) and AS (AUC=0.739) and non-significantly higher discrimination than STS (AUC=0.806, p=0.19). All contemporary models had acceptable calibration but the older LES (H-L p=0.024) did not. Estimated mortality was closest to observed mortality with the ES2 model. Both AES and LES over predicted mortality. The RSM with the highest discrimination in isolated coronary artery bypass graft surgery (CAGs) (AUC=0.847), isolated valves (AUC=0.830), and females (AUC=0.784) was the ES2 model. STS discrimination was highest in CAGs plus valve procedures (AUC 0.891), and males (STS AUC=0.891). Cut-off points for risk scores to define increased risk populations were 3.0% for ES2 and 1.7% for STS. Similar proportions of patients in each RSM (ES2-26% to STS-32%) were defined as higher risk by the model threshold score depending on type of procedure.

CONCLUSION

Among RSMs in contemporary use, ES2 and STS showed the best discrimination and acceptable calibration. Caution is recommended in specific subgroups. Increased mortality risk score cut-off points could be identified for these two RSMs in this single-centre cohort.

Evaluation of the Impact of Virtual Reality-Enhanced Cardiac Rehabilitation on Depressive and Anxiety Symptoms in Patients with Coronary Artery Disease: A Randomised Controlled Trial

The aim of this study was to assess the efficacy of virtual reality (VR)-enhanced cardiac rehabilitation (CR) in reducing the intensity of depression and anxiety symptoms in patients undergoing phase II of CR in ambulatory conditions. One hundred participants (mean age 65.7 years) were divided randomly into two groups. Both groups took part in eight sessions of standard CR (three times per week). The experimental group was additionally supported by eight sessions of VR therapy using the VR TierOne device and the control group by eight sessions of Schultz Autogenic Training. The Hospital Anxiety and Depression Scale (HADS) was used as the primary outcome measure. The Perception of Stress Questionnaire was used as the secondary outcome measure. The data from 77 participants were subject to analysis. Post-intervention, in the experimental group, the overall HADS score was statistically significantly reduced by 13.5%, HADS-Depression by 20.8%, and the general stress level by 12.8% (p < 0.05). In the control group, the scores of the HADS, HADS-Anxiety and the general stress level were statistically significantly higher, by 4.8%, 6.5%, and 4.9%, respectively. VR-enhanced CR for individuals with cardiovascular disease reduced the level of anxiety and depression symptoms compared to standard CR.

Efficacy and cost-effectiveness of a therapist-assisted web-based intervention for depression and anxiety in patients with ischemic heart disease attending cardiac rehabilitation [eMindYourHeart trial]: a randomised controlled trial protocol

BACKGROUND

One in five patients with ischaemic heart disease (IHD) develop comorbid depression or anxiety. Depression is associated with risk of non-adherence to cardiac rehabilitation (CR) and dropout, inadequate risk factor management, poor quality of life (QoL), increased healthcare costs and premature death. In 2020, IHD and depression are expected to be among the top contributors to the disease-burden worldwide. Hence, it is paramount to treat both the underlying somatic disease as well as depression and anxiety. eMindYourHeart will evaluate the efficacy and cost-effectiveness of a therapist-assisted eHealth intervention targeting depression and anxiety in patients with IHD, which may help fill this gap in clinical care.

METHODS

eMindYourHeart is a multi-center, two-armed, unblinded randomised controlled trial that will compare a therapist-assisted eHealth intervention to treatment as usual in 188 CR patients with IHD and comorbid depression or anxiety. The primary outcome of the trial is symptoms of depression, measured with the Hospital Anxiety and Depression Scale (HADS) at 3 months. Secondary outcomes evaluated at 3, 6, and 12 months include symptoms of depression and anxiety (HADS), perceived stress, health complaints, QoL (HeartQoL), trial dropout (number of patients dropped out in either arm at 3 months) and cost-effectiveness.

DISCUSSION

To our knowledge, this is the first trial to evaluate both the efficacy and cost-effectiveness of a therapist-assisted eHealth intervention in patients with IHD and comorbid psychological distress as part of CR. Integrating screening for and treatment of depression and anxiety into standard CR may decrease dropout and facilitate better risk factor management, as it is presented as "one package" to patients, and they can access the eMindYourHeart program in their own time and at their own convenience. The trial holds a strong potential for improving the quality of care for an increasing population of patients with IHD and comorbid depression, anxiety or both, with likely benefits to patients, families, and society at large due to potential reductions in direct and indirect costs, if proven successful. Trial registration The trial was prospectively registered on https://clinicaltrials.gov/ct2/show/NCT04172974 on November 21, 2019 with registration number [NCT04172974].

Elections have Consequences: Partisan Politics may be Literally Killing Us

BACKGROUND

Presidential campaigns and election outcomes have significant health implications for voters and communities. The theoretical underpinning of this relationship is multifaceted, but a new and growing field of empirical literature strongly suggests communities that voted for the losing presidential candidate may experience decreased physical and mental health under the leadership of the winning candidate.

OBJECTIVE

Our objective was to estimate the relationship between mortality rates and community support for the losing presidential candidate (partisan loss).

METHODS

Mortality data compiled by the US Centers for Disease Control and election results at the county level were used across a suite of county-year fixed-effects models to estimate the effect of election outcomes on mortality rates for the years 1999-2017.

RESULTS

Mortality rates were positively associated with partisan loss. Results suggest mortality rates increase by as much as 3% in extremely partisan counties following presidential election losses.

CONCLUSIONS

We suggest two mechanisms-social disintegration and/or partisan theory-by which mortality rates are likely to increase for counties that voted for the losing presidential candidate.

Economic menace of diabetes in India: a systematic review

AIM

Diabetes mellitus is recognised as a major chronic pandemic disease that does not consider any ethnic and monetary background. There is a dearth of literature on the cost of diabetes in the Indian context. Therefore, the present study aims to capture the evidence from the literature on the cost of diabetes mellitus in India.

METHODS

An extensive literature was reviewed from ACADEMIA, NCBI, PubMed, ProQuest, EBSCO, Springer, JSTOR, Scopus and Google Scholar. The eligibility criterion is based on 'PICOS' procedure, and only those studies which are available in the English language, published between 1999 and February 2019, indexed in ABDC, EBSCO, ProQuest, Scopus and peer-reviewed journals are included.

RESULTS

A total of thirty-two studies were included in the present study. The result indicates that the median direct cost of diabetes was estimated to be ₹18,890/- p.a. for the north zone, ₹10,585/- p.a. for the south zone, ₹45,792/- p.a. for the north-east zone and ₹8822/- p.a. for the west zone. Similarly, the median indirect cost of diabetes was ₹18,146/- p.a. for the north zone, ₹1198/- p.a. for the south zone, ₹18,707/- p.a. for the north-east and ₹3949/- p.a. for the west zone.

CONCLUSION

The present study highlighted that diabetes poses a high economic burden on individuals/households. The study directed the need to arrange awareness campaign regarding diabetes and associated risk factors in order to minimise the burden of diabetes.

Reducing cardiovascular risk among people living with HIV: Rationale and design of the INcreasing Statin Prescribing in HIV Behavioral Economics REsearch (INSPIRE) randomized controlled trial

Cardiovascular disease (CVD) is a major cause of morbidity among people living with HIV (PLWH). Statins can safely and effectively reduce CVD risk in PLWH, but evidence-based statin therapy is under-prescribed in PLWH. Developed using an implementation science framework, INcreasing Statin Prescribing in HIV Behavioral Economics REsearch (INSPIRE) is a stepped-wedge cluster randomized trial that addresses organization-, clinician- and patient-level barriers to statin uptake in Los Angeles community health clinics serving racially and ethnically diverse PLWH. After assessing knowledge about statins and barriers to clinician prescribing and patient uptake, we will design, implement and measure the effectiveness of (1) educational interventions targeting leadership, clinicians, and patients, followed by (2) behavioral economics-informed clinician feedback on statin uptake. In addition, we will assess implementation outcomes, including changes in clinician acceptability of statin prescribing for PLWH, clinician acceptability of the education and feedback interventions, and cost of implementation.

Association between heart-focused anxiety, depressive symptoms, health behaviors and healthcare utilization in patients with coronary heart disease

OBJECTIVE

To analyze the association between heart-focused anxiety, depressive symptoms, health behaviors and healthcare utilization in patients with coronary heart disease (CHD).

METHODS

N = 1007 patients with CHD were recruited in hospital and followed for one year in a two-site cohort study. Heart focused anxiety (Cardiac Anxiety Questionnaire [CAQ] with the three subscales fear, attention, and avoidance), depressive symptoms (depression module from the Patient Health Questionnaire [PHQ-9]), health behaviors and healthcare utilization (smoking status, alcohol consumption, physical activity, outpatient physician/psychotherapist visits) were assessed six months after the initial hospitalization. Multiple regression models were used for statistical analysis.

RESULTS

About one third of the sample exhibited clinically significant CAQ scores. Higher CAQ-avoidance scores were associated with current smoking (OR = 1.62; 95%CI: 1.33-1.98), reduced alcohol intake (OR = 0.83; 95%CI: 0.71-0.98), non-participation in a coronary exercise group (OR = 1.76; 95%CI: 1.42-2.17), less regular physical activity (OR = 2.69; 95%CI: 2.32-3.12), and more frequent contact to general practitioners (GPs; b = 0.07, SE: 0.03). CAQ-attention was associated with non-smoking (OR = 0.51; 95%CI: 0.37-0.70), exercise group participation (OR = 0.69; 95%CI: 0.51-0.94), more frequent regular physical activity (OR = 0.55; 95%CI: 0.44-0.68), and more frequent contact to specialists for internal medicine (b = 0.09, SE: 0.04). CAQ-fear was not associated with any of the health behavior or healthcare use measures. Depressive symptoms were associated with reduced regular physical activity (OR = 1.05; 95%CI: 1.02-1.08) and increased contact to mental care specialists (b = 0.03, SE: 0.01) and GPs (b = 0.02, SE: 0.01).

CONCLUSIONS

Heart-focused anxiety and depressive symptoms may impede secondary prevention in patients with CHD and increase outpatient healthcare utilization.

Psychological distress and medication use for secondary prevention of cardiovascular events: Evidence from a large-scale population-based cohort study

OBJECTIVE

Cardiac patients with psychological distress have a poorer prognosis than patients without distress, potentially reflecting differences in preventive care. We aimed to examine distress-related variation in guideline-recommended medication use for secondary prevention of cardiovascular disease (CVD).

METHODS

Baseline questionnaire data from the 45 and Up Study (collected 2006-2009) were linked to hospitalisation, pharmaceutical dispensing and death records (to exclude those who died). Among participants hospitalised with myocardial infarction, angina, stroke/transient ischaemic attack in the six years before the questionnaire, Modified Poisson regression was used to estimate relative risks (RR) for distress (Kessler 10 scores: low[10- < 12], mild[12- < 16], moderate[16- < 22] and high[22-50]) and use of both blood pressure- and lipid-lowering medications, and use of neither medication in the three months following the questionnaire, adjusting for sociodemographic and health characteristics.

RESULTS

Among 7598 participants, 34.0% had low, 35.4% mild, 18.3% moderate and 12.3% high psychological distress. Around two-thirds (63.4%) were using both medications and the proportion declined with increasing levels of distress: RRs were 1.01(95%CI:0.97-1.05), 0.95(0.90-1.00) and 0.91(0.86-0.97) for mild, moderate and high compared to low distress, respectively (p(trend) = 0.001). The proportion using neither medication was 9.1% and increased with increasing distress: RRs for mild, moderate and high compared to low distress were 0.99(0.82-1.19), 1.30(1.06-1.59) and 1.60(1.28-1.98), respectively (p(trend) < 0.001).

CONCLUSION

Patients with psychological distress may need more support to optimise their use of secondary CVD prevention medications. Increasing the use of these medications for distressed patients may improve prognosis for patients with distress and improve population-level secondary prevention of CVD more broadly.

Addressing the psychosocial needs of patients: Challenges for nursing students

PURPOSE

To evaluate the ability of nursing students to determine the psychosocial needs of patients and identify the needs and problems encountered by nursing students.

DESIGN AND METHODS

This study is a mixed method research. The nursing care plans of 40 nursing students that provided care to 129 patients with chronic medical diseases were examined retrospectively. Individual interviews were also conducted with five nursing students and six academicians.

FINDINGS

It was determined that nursing students defined an average of 15.77 ± 11.55 physiological and an average of 3.05 ± 2.28 psychosocial nursing diagnoses for 129 patients. Data analysis of individual interviews revealed two main themes: (1) identifying psychosocial diagnoses: teaching difficulties and (2) identifying psychosocial diagnoses: learning difficulties.

PRACTICE IMPLICATIONS

This can facilitate the learning process of each student to include physiological and a psychosocial care focus in their nursing care through discussions and evaluation with their mentors and instructors.

Use of Well-Being in Identification of Members With Future Health Risk Factors and Future Diagnosed Chronic Disease

OBJECTIVE

To evaluate if well-being is associated with the development of future health risks or incidence of new chronic disease.

METHODS

A retrospective cohort study was employed using longitudinal well-being assessment survey data from participants of a Fortune 500 US company wellness program, claims based International Classification of Diseases, Ninth Revision diagnoses, and Cox proportional hazards models to assess associations between well-being and well-being change with future health risk and chronic disease incidence.

RESULTS

Individuals who maintained high well-being and those who increased their level of well-being displayed a significantly decreased hazard of accruing new health risk and new chronic disease incidence; those whose well-being worsened over time showed significant increases in health risk and hazard of new chronic disease incidence.

CONCLUSIONS

Well-being levels and change over time are significantly associated with future development of health risk and disease incidence.

Economic Impact of Subsequent Depression in Patients With a New Diagnosis of Stable Angina: A Population-Based Study

BACKGROUND

Depression is strongly linked to increased morbidity and mortality in patients with chronic stable angina; however, its associated healthcare costs have been less well studied. Our objective was to identify the characteristics of chronic stable patients found to have depression and to determine the impact of an occurrence of depression on healthcare costs within 1 year of a diagnosis of stable angina.

METHODS AND RESULTS

In this population-based study conducted in Ontario, Canada, we identified patients diagnosed with stable angina based on angiogram between October 1, 2008, and September 30, 2013. Depression was ascertained by physician billing codes and hospital admission diagnostic codes contained within administrative databases. The primary outcome was cumulative mean 1-year healthcare costs following index angiogram. Generalized linear models were developed with a logarithmic link and γ distribution to determine predictors of cost. Our cohort included 22 917 patients with chronic stable angina. Patients with depression had significantly higher mean 1-year healthcare costs ($32 072±$41 963) than patients without depression ($23 021±$25 741). After adjustment for baseline comorbidities, depression was found to be a significant independent predictor of cost, with a cost ratio of 1.33 (95% confidence interval, 1.29-1.37). Higher costs in depressed patients were seen in all healthcare sectors, including acute and ambulatory care.

CONCLUSIONS

Depression is an important driver of healthcare costs in patients following a diagnosis of chronic stable angina. Further research is needed to understand whether improvements in the approach to diagnosis and treatment of depression will translate to reduced expenditures in this population.

Towards Robot-Assisted Echocardiographic Monitoring in Catheterization Laboratories : Usability-Centered Manipulator for Transesophageal Echocardiography

This paper proposes a robotic Transesophageal Echocardiography (TOE) system concept for Catheterization Laboratories. Cardiovascular disease causes one third of all global mortality. TOE is utilized to assess cardiovascular structures and monitor cardiac function during diagnostic procedures and catheter-based structural interventions. However, the operation of TOE underlies various conditions that may cause a negative impact on performance, the health of the cardiac sonographer and patient safety. These factors have been conflated and evince the potential of robot-assisted TOE. Hence, a careful integration of clinical experience and Systems Engineering methods was used to develop a concept and physical model for TOE manipulation. The motion of different actuators of the fabricated motorized system has been tested. It is concluded that the developed medical system, counteracting conflated disadvantages, represents a progressive approach for cardiac healthcare.

Cost-Effectiveness of a Collaborative Care Depression and Anxiety Treatment Program in Patients with Acute Cardiac Illness

OBJECTIVE

To use data from a randomized trial to determine the cost-effectiveness of a collaborative care (CC) depression and anxiety treatment program and to assess effects of the CC program on health care utilization.

METHODS

The CC intervention's impact on health-related quality of life, depression-free days (DFDs), and anxiety-free days (AFDs) over the 24-week postdischarge period was calculated and compared with the enhanced usual care (EUC) condition using independent samples t tests and random-effects regression models. Costs for both the CC and EUC conditions were calculated on the basis of staff time, overhead expenses, and treatment materials. Using this information, incremental cost-effectiveness ratios were calculated. A cost-effectiveness acceptability plot was created using nonparametric bootstrapping with 10,000 replications, and the likelihood of the CC intervention's cost-effectiveness was assessed using standard cutoffs. As a secondary analysis, we determined whether the CC intervention led to reductions in postdischarge health care utilization and costs.

RESULTS

The CC intervention was more costly than the EUC intervention ($209.86 vs. $34.59; z = -11.71; P < 0.001), but was associated with significantly greater increases in quality-adjusted life-years (t = -2.49; P = 0.01) and DFDs (t = -2.13; P = 0.03), but not AFDs (t = -1.92; P = 0.057). This translated into an incremental cost-effectiveness ratio of $3337.06 per quality-adjusted life-year saved, $13.36 per DFD, and $13.74 per AFD. Compared with the EUC intervention, the CC intervention was also associated with fewer emergency department visits but no differences in overall costs.

CONCLUSIONS

This CC intervention was associated with clinically relevant improvements, was cost-effective, and was associated with fewer emergency department visits in the 24 weeks after discharge.

Association between allergic rhinitis and metabolic conditions: a nationwide survey in Korea

Background

Accumulating evidence indicates a strong correlation between allergic disease and cardiovascular risks. In spite of this, the data concerning the association between allergic rhinitis (AR) and cardiovascular risks is sparse and conflicting. This study aimed to investigate the association between AR prevalence and metabolic syndrome (MetS) in a large-scale, population-based survey, while considering the relevant risk factors.

Methods

A nationwide cross-sectional study was conducted based on data from 30,590 subjects aged 19 years and older, from the Korean National Health and Nutrition Survey 2007–2013. The odds ratios (ORs) and 95 % confidence intervals (CIs) of AR prevalence, based on MetS status and the presence of any MetS component, were calculated using multiple logistic regression analyses.

Results

Regarding the characteristics of patients with AR and/or MetS, some variables had significant associations with disease in inverse directions for AR and MetS. Multivariate logistic analysis, with adjustments for demographic variables and health habits, indicated that AR prevalence was significantly lower in subjects with MetS (OR 0.84; 95 % CI 0.76–0.93), high blood pressure (OR 0.85; 95 % CI 0.77–0.94), or impaired fasting glucose (OR 0.81; 95 % CI 0.73–0.89). Furthermore, high blood pressure and impaired fasting glucose were significant predictors for reduced AR prevalence, independently of other MetS components.

Conclusion

In this population, AR was diagnosed less frequently in subjects with metabolic conditions. Well-designed prospective studies allowing for medical service utilization and collaborative basic research are warranted to elucidate the mechanism responsible for this inverse relationship.

Incident depression increases medical utilization in Medicaid patients with hypertension

Hypertension is an important risk factor for cardiovascular disease and occurs disproportionately among patients with depression. Few studies have rigorously examined outcomes specifically among hypertensive patients with newly diagnosed comorbid depression.

AIM

We hypothesized that incident depression would exacerbate hypertensive disease and that this would be evident through greater utilization of medical services than would otherwise occur in the absence of depression.

METHODS

Claims data for hypertensive patients enrolled in Maryland Medicaid (2005-2010) were used to estimate the change in annualized utilization following incident depression, compared to a matched cohort of hypertensive patients never diagnosed with depression. Multivariate regression was used to adjust for changes in antihypertensive medications, adherence and comorbidity that followed depression onset.

RESULTS

While medical utilization increased after incident depression, additional encounters tended to be for nonacute medical care and there was no significant increase in encounters specifically for cardiovascular or hypertension-related conditions.

DISCUSSION

The results contribute to the discussion on the relationship between depression and cardiovascular disease and will inform future studies that aim to look at longer term outcomes in patients with hypertension.