The burden of cardiovascular morbidity in a European Mediterranean population with multimorbidity: a cross-sectional study

The role of life satisfaction and living arrangements in the association between chronic disease and depression: a national cross-sectional survey

Introduction

For middle-aged and older people, depression is a frequent and prevalent illness. The purpose of this study was to examine the moderating function of living arrangements in the mediating model as well as the mediating role of life satisfaction in the association between chronic diseases and depressive symptoms.

Methods

The China Health and Retirement Longitudinal Study (CHARLS) provided the data for this investigation (2018). Respondents were grouped according to depression status to compare the differences between middle-aged and older people with different depression statuses. The moderating effect of living arrangements and the mediating effect of life satisfaction were tested using the Bootstrap program and the simple slope approach.

Results

The population's total prevalence of depressive symptoms was 30.3%. According to the mediating effect research, middle-aged and older people with chronic diseases experienced substantial direct effects on depressive symptoms (β = 1.011, p < 0.001). It has been established that life satisfaction has an 18.6% mediation effect between depressive symptoms and chronic diseases. Regarding the further moderating influence, it was discovered that chronic diseases had a more significant impact on the life satisfaction of middle-aged and older people who are in live alone than those who are living with others (β = 0.037, p < 0.05).

Conclusion

In middle-aged and older people, chronic diseases have a major influence on depressive symptoms. Life satisfaction mediated the relationship between chronic diseases and depressive symptoms, and living arrangements moderated the first part of the route in the mediation model. Therefore, life satisfaction and living arrangements should be important considerations to decrease the prevalence of depressive symptoms in middle-aged and older people.

Statin therapy in multimorbid older patients with polypharmacy- a cross-sectional analysis of the Swiss OPERAM trial population

Background

Statin therapy in multimorbid older individuals with polypharmacy is controversial, particularly in primary prevention of cardiovascular disease. Thereby, physicians must weigh potential benefits against potential side effects, drug-drug interactions, and limited life expectancy.

Aim

To assess the prevalence and determinants of potentially inappropriate statin therapy in multimorbid older patients.

Methods

We conducted a cross-sectional analysis of patients aged ≥70 years with multimorbidity and polypharmacy in the Swiss study center of OPERAM, a cluster-randomized trial on pharmacotherapy optimization to reduce drug-related hospital admissions. We assessed potential underuse (no statin but formal indication) and potential overuse (statin but no formal indication, including predicted >60% one-year mortality based on the Walter Score) based on current guidelines for patients in secondary and primary cardiovascular prevention. We assessed the association of potential statin overuse and underuse with six patient characteristics (age, gender, number of diagnoses, number of medications, mental impairment, being housebound) in LASSO-selection analyses.

Results

Of 715 multimorbid older adults (79.7 ± 6.5 years, 39.9% women), 337 (47%) were on statin. Statin therapy was appropriate in 474 (66.3%), underused in 130 (18.2%), and overused in 111 (15.5%) patients. In participants in secondary cardiovascular prevention (n = 437), being female (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.67-4.22) was significantly associated with potential underuse while being housebound (OR 3.53, 95%CI 1.32-9.46) and taking ≥10 medications (OR 1.95,95%CI 1.05-3.67) were associated with potential overuse. In participants in primary cardiovascular prevention (n = 278), 28.1% were potentially under- (9%) or overusing (19%) a statin, with no identified risk factor.

Conclusion

A third of hospitalized multimorbid older patients with polypharmacy potentially (either) overused or underused statin therapy. Among patients in secondary cardiovascular prevention, women were at risk for potential statin underuse. Housebound patients and those taking ≥10 medications were at risk for potential overuse of a statin. Physicians should carefully evaluate the indication for statin prescription in multimorbid older patients with polypharmacy.

Social determinants of multimorbidity patterns: A systematic review

Social determinants of multimorbidity are poorly understood in clinical practice. This review aims to characterize the different multimorbidity patterns described in the literature while identifying the social and behavioral determinants that may affect their emergence and subsequent evolution. We searched PubMed, Embase, Scopus, Web of Science, Ovid MEDLINE, CINAHL Complete, PsycINFO and Google Scholar. In total, 97 studies were chosen from the 48,044 identified. Cardiometabolic, musculoskeletal, mental, and respiratory patterns were the most prevalent. Cardiometabolic multimorbidity profiles were common among men with low socioeconomic status, while musculoskeletal, mental and complex patterns were found to be more prevalent among women. Alcohol consumption and smoking increased the risk of multimorbidity, especially in men. While the association of multimorbidity with lower socioeconomic status is evident, patterns of mild multimorbidity, mental and respiratory related to middle and high socioeconomic status are also observed. The findings of the present review point to the need for further studies addressing the impact of multimorbidity and its social determinants in population groups where this problem remains invisible (e.g., women, children, adolescents and young adults, ethnic groups, disabled population, older people living alone and/or with few social relations), as well as further work with more heterogeneous samples (i.e., not only focusing on older people) and using more robust methodologies for better classification and subsequent understanding of multimorbidity patterns. Besides, more studies focusing on the social determinants of multimorbidity and its inequalities are urgently needed in low- and middle-income countries, where this problem is currently understudied.

Multimorbidity Patterns and Their Association with Social Determinants, Mental and Physical Health during the COVID-19 Pandemic

BACKGROUND

The challenge posed by multimorbidity makes it necessary to look at new forms of prevention, a fact that has become heightened in the context of the pandemic. We designed a questionnaire to detect multimorbidity patterns in people over 50 and to associate these patterns with mental and physical health, COVID-19, and possible social inequalities.

METHODS

This was an observational study conducted through a telephone interview. The sample size was 1592 individuals with multimorbidity. We use Latent Class Analysis to detect patterns and SF-12 scale to measure mental and physical quality-of-life health. We introduced the two dimensions of health and other social determinants in a multinomial regression model.

RESULTS

We obtained a model with five patterns (entropy = 0.727): 'Relative Healthy', 'Cardiometabolic', 'Musculoskeletal', 'Musculoskeletal and Mental', and 'Complex Multimorbidity'. We found some differences in mental and physical health among patterns and COVID-19 diagnoses, and some social determinants were significant in the multinomial regression.

CONCLUSIONS

We identified that prevention requires the location of certain inequalities associated with the multimorbidity patterns and how physical and mental health have been affected not only by the patterns but also by COVID-19. These findings may be critical in future interventions by health services and governments.

2022 Prevention of chronic non-communicable diseases in Of the Russian Federation. National guidelines

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Multimorbidity in cardiovascular disease and association with life satisfaction: a Chinese national cross-sectional study

BACKGROUND

The coexistence of multiple chronic conditions is very common in cardiovascular disease (CVD). However, the prevalence of CVD multimorbidity in China and its influence on life satisfaction have not been reported. This study aimed to investigate the proportions of 12 chronic comorbid diseases in CVD and the associations of multimorbidity with life satisfaction in patients with CVD.

METHODS

We conducted a cross-sectional study in a nationally representative sample of 3478 participants with CVD aged 45 years or more who participated in the China Health and Retirement Longitudinal Study 2015. Correlations of multimorbidity with 12 chronic diseases in CVD and life satisfaction were investigated using logistic regression models, after adjusting for 12 covariates.

RESULTS

The proportion of multimorbidity among participants with CVD was 93.3% (89.4% for middle-aged adults and 95.4% for older adults; 92.9% for men and 93.5% for women). The proportion of participants with CVD multimorbidity who were dissatisfied with life was 11.2%, significantly higher than those without any chronic diseases (χ²=5.147, p=0.023). Life satisfaction in patients with CVD decreased with increased number of comorbidities (χ²=45.735, p<0.001). Kidney disease (OR=1.933, 95% CI: 1.483 to 2.521), memory-related diseases (MRDs) (OR=1.695, 95% CI: 1.149 to 2.501) and dyslipidaemia (OR=1.346, 95% CI: 1.048 to 1.729) were significantly associated with reduced life satisfaction when adjusting for 12 covariates.

CONCLUSIONS

In this nationally representative cross-sectional study, life satisfaction was reduced by multimorbidity of CVD. Kidney disease had the greatest influence on life satisfaction in patients with CVD, followed by dyslipidaemia and MRDs. Our study emphasises the importance of preventing of chronic diseases in adults with CVD.

Association between adherence to the Mediterranean diet and the prevalence of cardiovascular risk factors

Objective:

to determine the prevalence of cardiovascular risk factors in a cohort of workers and to quantify its association with compliance with the Mediterranean diet follow-up.

Method:

a cross-sectional descriptive study was carried out on a cohort of 23,729 workers. Clinical data from annual medical examinations and the Mediterranean Diet Adherence Screener were used to assess adherence to the Mediterranean diet.

Results:

51.3% of the participants showed good adherence to the Mediterranean diet. The multivariate analysis showed an inverse and significant association between the follow-up of the Mediterranean diet and the prevalence of abdominal obesity (Odds Ratio = 0.64, 95% CI 0.56; 0.73), dyslipidemia (Odds Ratio = 0.55, 95% CI 0.42; 0.73), and metabolic syndrome (Odds Ratio = 0.76, 95% CI 0.67; 0.86).

Conclusions:

our results suggest that the Mediterranean diet is potentially effective in promoting cardiovascular health. Implementing the interventions promoting the Mediterranean diet in the working population seems justified.

Systematic Review and Meta-Analysis of Medication Reviews Conducted by Pharmacists on Cardiovascular Diseases Risk Factors in Ambulatory Care

Background

Pharmacists‐led medication reviews (MRs) are claimed to be effective for the control of cardiovascular diseases; however, the evidence in the literature is conflicting. The main objective of this meta‐analysis was to analyze the impact of pharmacist‐led MRs on cardiovascular disease risk factors overall and in different ambulatory settings while exploring the effects of different components of MRs.

Methods and Results

Searches were conducted in PubMed, Web of Science, Embase, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library Central Register of Controlled Trials database. Randomized and cluster randomized controlled trials of pharmacist‐led MRs compared with usual care were included. Settings were community pharmacies and ambulatory clinics. The classification used for MRs was the Pharmaceutical Care Network Europe as basic (type 1), intermediate (type 2), and advanced (type 3). Meta‐analyses in therapeutic goals used odds ratios to standardize the effect of each study, and for continuous data (eg, systolic blood pressure) raw differences were calculated using baseline and final values, with 95% CIs. Prediction intervals were calculated to account for heterogeneity. Sensitivity analyses were conducted to test the robustness of results. Meta‐analyses included 69 studies with a total of 11 644 patients. Sample demographic characteristics were similar between studies. MRs increased control of hypertension (odds ratio, 2.73; 95% prediction interval, 1.05–7.08), type 2 diabetes mellitus (odds ratio, 3.11; 95% prediction interval, 1.17–5.88), and high cholesterol (odds ratio, 1.91; 95% prediction interval, 1.05–3.46). In ambulatory clinics, MRs produced significant effects in control of diabetes mellitus and cholesterol. For community pharmacies, systolic blood pressure and low‐density lipoprotein values decreased significantly. Advanced MRs had larger effects than intermediate MRs in diabetes mellitus and dyslipidemia outcomes. Most intervention components had no significant effect on clinical outcomes and were often poorly described. CIs were significant in all analyses but prediction intervals were not in continuous clinical outcomes, with high heterogeneity present.

Conclusions

Intermediate and advanced MRs provided by pharmacists may improve control of blood pressure, cholesterol, and type 2 diabetes mellitus, as statistically significant prediction intervals were found. However, most continuous clinical outcomes failed to achieve statistical significance, with high heterogeneity present, although positive trends and effect sizes were found. Studies should use a standardized method for MRs to diminish sources of these heterogeneities.

A prescription support-tool for chronic management of oral antithrombotic combinations in adults based on a systematic review of international guidelines

BACKGROUND

Oral antithrombotic (AT) drugs, which include antiplatelet and anticoagulant therapies, are widely implicated in serious preventable bleeding events. Avoiding inappropriate oral AT combinations is a major concern. Numerous practical guidelines have been released; a document to enhance prescriptions of oral AT combinations for adults would be of great help.

OBJECTIVE

To synthesize guidelines on the prescription of oral AT combinations in adults and to create a prescription support-tool for clinicians about chronic management (≥ one month) of oral AT combinations.

METHODS

A systematic review of guidelines published between January 2012 and April 2017, in English or in French, from Trip database, Guideline International Network and PubMed, dealing with the prescription of oral ATs in adults was conducted. In-hospital management of ATs, bridging therapy and switches of ATs were not considered. Some specific topics requiring specialized follow-up (cancer, auto-immune disease, haemophilia, HIV, paediatrics and pregnancy) were excluded. Last update was made in November 2018.

RESULTS

A total of 885 guidelines were identified and 70 met the eligibility criteria. A prescription support-tool summarizing medical conditions requiring chronic management of oral AT combinations in adults with drug types, dosage and duration, on a double-sided page, was provided and tested by an external committee of physicians. The lack of specific guidelines for old people (age 75 years and older) is questioned considering the specific vulnerability of this age group to serious bleedings.

CONCLUSIONS

Recommendations on prescriptions about chronic management of oral AT combinations in adults were mainly consensual but dispersed in numerous guidelines according to the medical indication. We provide a prescription support-tool for clinicians. Further studies are needed to assess the impact of this tool on appropriate prescribing and the prevention of serious adverse drug events.

Mini-encyclopaedia of the wound healing - Opportunities for integrating multi-omic approaches into medical practice

Wound healing is a highly complex life-important repair process triggered by plenty of local and/or systemic organ and tissue damaging events, such as an acute surgical invasion, accidental organ and tissue damages, acute and chronic diseases, aggressive local and systemic therapeutic approaches (e.g. irradiation and systemic chemotherapy). Individual health condition determines over the quality of wound healing. Impaired wound healing, in turn, may lead, for example, to post-surgical complications frequently observed in elderly, chronic ulcers in diabetic patients, hindered and ineffective pain management, etc. However, these well-acknowledged examples are just the tip of the iceberg. The entire spectrum of potential consequences is much broader. Therefore, all the aspects of wound healing need to receive a dedicated attention of many specialised medical fields and healthcare as a whole. In contrast, there is still strongly limited knowledge collected regarding the molecular and cellular mechanisms underlying the physiological versus impaired wound healing. The contents of this article might be of great importance for multi-professional considerations as well as for the experts working in specific fields such as clinical proteomics, general practice, laboratory medicine, surgery including plastic surgery and aesthetic medicine, gerontology, psychology, diabetology, endocrinology, oncology, cardiovascular disease, radiology, and healthcare economy.

SIGNIFICANCE

The contents of this article are strongly motivated by the particular value of wound healing quality for medical care and might be of great importance for multi-professional considerations and experts working in specialised fields: predictive and preventive medicine, general practitioners, laboratory medicine, surgery including plastic surgery and aesthetic medicine, gerontology, psychology, diabetology, endocrinology, oncology, cardiovascular disease, radiology, and healthcare economy. The article is aiming at both educational and scientific purposes: on one side it summarises comprehensive information available regarding wound healing mechanisms and molecular pathways involved. On the other side the article provides highly innovative hypotheses for multi-professional considerations relevant for several research fields which may potentially advance medical services in the close future such as clinical proteomics and multi-omics.