Optimization of the pharmacological therapy in patients with poly-vascular disease: A multidisciplinary approach

Availability, price and affordability of essential medicines for managing cardiovascular disease in Addis Ababa, Ethiopia

Access to health care is a fundamental human right. However, nearly one-third of the global population have no access to it. This magnitude is even much worse in low- and middle-income countries. A cross-sectional study was conducted from April 12 to June 5, 2024 to determine availability, price and affordability of essential medicines for managing cardiovascular diseases using WHO/HAI methodology in Addis Ababa, Ethiopia. Data on the availability and price of the lowest priced generic medicines were collected from five public, ten private and eight other sectors in Addis Ababa, Ethiopia. The availability was assessed as the percentage of health facilities that stocked the listed medicines. The prices of these medicines were evaluated across all sectors. Price variations were calculated to identify differences among these settings. Additionally, medicine prices were compared against the management sciences for health (MSH) International Reference Prices to calculate the Median Price Ratio (MPR), providing a standardized measure of price affordability and accessibility. The data was analyzed using WHO/HAI work book Excel sheet V 15. The overall availability of generic drugs in all sectors was found to be 34.52%. The availability was 33.73, 40.58, 29.8 and 33.99% in Public, Private, Kenema and Red Cross pharmacies, respectively. The median price ratios for the medications used to treat cardiovascular disease were 3.49, 7.24, 2.84 and 5.2 at Public, Private, Kenema, and Red Cross Pharmacies, respectively. Majority of the medicines were found to be unaffordable, costing up to 352.44 days' wage of the lowest paid government employee to cover a one-month standard treatment. In conclusion, the study underscores significant challenges in the availability, pricing, and affordability of LPG medications to treat CVDs in Ethiopia.

Ischemic cardio-cerebrovascular disease and all-cause mortality in Chinese elderly patients: a propensity-score matching study

BACKGROUND

Ischemic cardio-cerebrovascular disease is the leading cause of mortality worldwide. However, studies focusing on elderly and very elderly patients are scarce. Hence, our study aimed to characterize and investigate the long-term prognostic implications of ischemic cardio-cerebrovascular diseases in elderly Chinese patients.

METHODS

This retrospective cohort study included 1026 patients aged ≥ 65 years who were categorized into the mono ischemic cardio-cerebrovascular disease (MICCD) (either coronary artery disease or ischemic stroke/transient ischemic attack) (n = 912) and the comorbidity of ischemic cardio-cerebrovascular disease (CICCD) (diagnosed with both coronary artery disease and ischemic stroke/transient ischemic attack at admission) (n = 114). The primary outcome was all-cause death. The mortality risk was evaluated using the Cox proportional hazards risk model with multiple adjustments by conventional and propensity-score-based approaches.

RESULTS

Of the 2494 consecutive elderly patients admitted to the hospital, 1026 (median age 83 years [interquartile range]: 76.5-86.4; 94.4% men) met the inclusion criteria. Patients with CICCD consisted mostly of very elderly (79.2% vs. 66.1%, P < 0.001) individuals with a higher burden of comorbidities. Over a median follow-up of 10.4 years, 398 (38.8%) all-cause deaths were identified. Compared with the MICCD group, the CICCD group exhibited a higher adjusted hazard ratio (HR) (95% confidential interval, CI) of 1.71 (1.32-2.39) for long-term mortality after adjusting for potential confounders. The sensitivity analysis results remained robust. After inverse probability of treatment weighting (IPTW) modeling, the CICCD group displayed an even worse mortality risk (IPTW-adjusted HR: 2.07; 95% CI 1.47-2.90). In addition, anemia (adjusted HR: 1.48; 95% CI 1.16-1.89) and malnutrition (adjusted HR: 1.43; 95% CI 1.15-1.78) are also independent risk factors for all-cause mortality among elderly and very elderly patients.

CONCLUSIONS

Our results thus suggest that elderly patients with ischemic cardio-cerebrovascular disease and anemia or malnutrition may have higher mortality, which may be predicted upon admission. These findings, however, warrant further investigation.

Undercover Peripheral Arterial Disease

Peripheral arterial disease is a frequently underdiagnosed disease that can severely affect the quality of life. We present a clinical case of a 62-year-old smoker post-menopause woman with a mild stroke. Further investigation revealed a severe disseminated arterial disease. Due to multidisciplinary and timely interventions, peripheral ischemia was prevented successfully. In fact, this patient had polyvascular disease. Despite its worst prognosis than either coronary artery disease, cerebrovascular disease, or peripheral arterial disease alone, polyvascular disease is still underdiagnosed. Atherosclerosis and cardiovascular risk should be regarded as multisystemic and managed as such in multidisciplinary teams. A proper and timely intervention is essential to diminish its morbidity and mortality.