Secondary Prevention in Concurrent Coronary Artery, Cerebrovascular, and Chronic Kidney Disease: Focus on Pharmacological Therapy

Estimate of the prevalence of subjects with chronic diseases in a province of Northern Italy: a retrospective study based on administrative databases

OBJECTIVE

To find a definition of chronic disease based on literature review and to estimate the population-based prevalence rate of chronicity in a province in Northern Italy.

DESIGN

Retrospective observational study based on administrative databases.

DATA SOURCES/SETTING

Archives of the National Health Service that contain demographic and administrative information linked with the archives of ticket exemptions (2000-2019), the hospital discharge and drug prescriptions (2016-2019).

PARTICIPANTS

Subjects who lived in Vercelli Local Health Authority, a Northern Italian province (Piedmont region), and were alive in December 2019.

MAIN OUTCOME MEASURES

Prevalence of subjects with at least one chronic disease identified by administrative sources and stratification of population according to the number of comorbidities. The pathologies considered were: chronic ischaemic heart disease, congestive heart failure, cardiac arrhythmias, hypertension, stroke, neoplasm, asthma, chronic obstructive pulmonary disease, diabetes, thyroid disorders, osteoporosis, rheumatoid arthritis, chronic kidney disease, dementia, autism spectrum disorder, depression, schizophrenia, hepatitis, HIV and substance use disorders.

RESULTS

Our target population was about 164 344 subjects. The overall prevalence of subjects with at least one chronic condition was 21.43% (n=35 212): 19 541 were female and 15 671 were male with a raw prevalence of 22.96% and 19.77%, respectively. The overall prevalence increases with age until 85 years old, then a decrease is observed. Moreover, 16.39% had only one pathology, 4.30% two diseases and 0.74% had a more complex clinical condition (more than three diseases).

CONCLUSIONS

Despite the difficulty of having a unique definition of chronic disease, the prevalence obtained was coherent with the estimates reported by other national surveillance systems such as Passi and Passi d'Argento. Underestimates were observed when international comparisons were done; however, when we used less stringent definitions of chronic diseases, similar results were obtained.

MR imaging of the coronary vasculature: imaging the lumen, wall, and beyond

The characteristics of coronary artery disease are gradual thickening of the coronary walls and narrowing of the vascular lumen by the buildup of atherosclerosis plaques. These morphologic changes can be noninvasively detected by coronary magnetic resonance (MR) imaging/MR angiography (MRA). In addition, functional changes, such as coronary wall distensibility and flow changes, may also be evaluated with MR imaging. However, the application of current MR imaging/MRA techniques is limited in clinical practice because of several adverse technical and physiologic factors, such as cardiac and respiratory motion. Many technical innovations have been adopted to address these problems from multiple aspects.

Using published criteria to develop a list of potentially inappropriate medications for elderly patients in Taiwan

BACKGROUND

Explicit criteria for potentially inappropriate medications (PIMs) developed from other regions were often difficult to apply to a specific territory without significant modifications.

PURPOSE

To describe a process of developing a country-specific explicit PIM criteria from quality review of several published PIM criteria, followed by consensus among regional experts in Taiwan.

METHODS

After a review of the literature, we selected seven sets of published PIM criteria. Medications/medication classes listed in at least three of the seven sets of criteria were selected as preliminary core PIMs. We asked a group of 21 experts from various specialties to rate how appropriate they found inclusion of each medication/medication class in final PIM criteria after two rounds of modified Delphi methods.

RESULTS

Table 1 of the instrument included 24 medication/medication classes to be generally avoided in older adults irrespective of co-morbidities, and Table 2 included 12 chronic conditions with six medication/medication classes that patients with these conditions should avoid. The Taiwan criteria contained only half the number of statements that were included in the Beers criteria (36 vs 68 statements) but detected nearly 70-75% as many PIMs in older patients with polypharmacy in a secondary data analysis. Features included straightforward statement arrangements, suggestions of alternatives, and clear definitions of long-acting benzodiazepine and anticholinergic drugs for Table 1 PIMs.

CONCLUSION

A user-friendly instrument was developed to detect PIMs for Taiwanese older adults. Further prospective studies are needed to validate its use in clinical and research settings.