Longevity of posterior composite restorations: a systematic review and meta-analysis

The aim of this meta-analysis, based on individual participant data from several studies, was to investigate the influence of patient-, materials-, and tooth-related variables on the survival of posterior resin composite restorations. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a search resulting in 12 longitudinal studies of direct posterior resin composite restorations with at least 5 years' follow-up. Original datasets were still available, including placement/failure/censoring of restorations, restored surfaces, materials used, reasons for clinical failure, and caries-risk status. A database including all restorations was constructed, and a multivariate Cox regression method was used to analyze variables of interest [patient (age; gender; caries-risk status), jaw (upper; lower), number of restored surfaces, resin composite and adhesive materials, and use of glass-ionomer cement as base/liner (present or absent)]. The hazard ratios with respective 95% confidence intervals were determined, and annual failure rates were calculated for subgroups. Of all restorations, 2,816 (2,585 Class II and 231 Class I) were included in the analysis, of which 569 failed during the observation period. Main reasons for failure were caries and fracture. The regression analyses showed a significantly higher risk of failure for restorations in high-caries-risk individuals and those with a higher number of restored surfaces.

A pharmacist-led prospective antibiotic stewardship intervention improves compliance to community-acquired pneumonia guidelines in 39 public and private hospitals across South Africa

INTRODUCTION

Pharmacists in low-middle-income countries (LMIC) are few and lack antibiotic stewardship (AS) training. The ability was assessed of non-specialised pharmacists to implement stewardship interventions and improve adherence to the South African community-acquired pneumonia (CAP) guideline in public and private hospitals.

METHODS

This was a multicentre, prospective cohort study of adult CAP patients hospitalised between July 2017 and July 2018. A CAP bundle was developed of seven process measures (diagnostic and AS) that pharmacists used to audit compliance and provide feedback. CAP bundle compliance rates and change in outcome measures [mortality, length of stay (LOS) and infection-related (IR)-LOS] during pre- and post-implementation periods were compared.

RESULTS

In total, 2464 patients in 39 hospitals were included in the final analysis. Post-implementation, overall CAP bundle compliance improved from 47·8% to 53·6% (confidence interval [CI] 4·1-7·5, p<0·0001), diagnostic stewardship compliance improved from 49·1% to 54·6% (CI 3·3-7·7, p<0·0001) and compliance with AS process measures from 45·3% to 51·6% (CI 4·0-8·6, p<0·0001). Improved compliance with process measures was significant for five (2 diagnostic, 3 AS) of seven components: radiology, laboratory, antibiotic choice, duration and intravenous to oral switch. There was no difference in mortality between the two phases, [4·4%(55/1247) vs. 3·9%(47/1217); p=0·54], median LOS or IR LOS 6·0 vs. 6·0 days (p=0·20) and 5·0 vs. 5·0 days (p=0·40).

CONCLUSION

Non-specialised pharmacists in public and private hospitals implemented stewardship interventions and improved compliance to SA CAP guidelines. The methodology of upskilling and a shared learning stewardship model may benefit LMIC countries.

Social Media and COVID-19—Perceptions and Public Deceptions of Ivermectin, Colchicine and Hydroxychloroquine: Lessons for Future Pandemics

The capacity for social media to influence the utilization of re-purposed medicines to manage COVID-19, despite limited availability of safety and efficacy data, is a cause for concern within health care systems. This study sought to ascertain links between social media reports and utilization for three re-purposed medicines: hydroxychloroquine (HCQ), ivermectin and colchicine. A combined retrospective analysis of social media posts for these three re-purposed medicines was undertaken, along with utilization and clinical trials data, in South Africa, between January 2020 and June 2021. In total, 77,257 posts were collected across key social media platforms, of which 6884 were relevant. Ivermectin had the highest number of posts (55%) followed by HCQ (44%). The spike in ivermectin use was closely correlated to social media posts. Similarly, regarding chloroquine (as HCQ is not available in South Africa), social media interest was enhanced by local politicians. Sentiment analysis revealed that posts regarding the effectiveness of these repurposed medicines were positive. This was different for colchicine, which contributed only a small number of mentions (1%). Of concern is that the majority of reporters in social media (85%) were unidentifiable. This study provides evidence of social media as a driver of re-purposed medicines. Healthcare professionals have a key role in providing evidence-based advice especially with unidentifiable posts.

Effect of salivary factors on the susceptibility of hydroxyapatite to early erosion

OBJECTIVE

Salivary pellicle is known to reduce the erosion of enamel and differences in the level of protection exist between individual saliva sources, but which parameters or components are important is not known. The focus of this study was to investigate the relationship between saliva parameters and early erosion of hydroxyapatite (HAp) with an in situ grown saliva film.

METHODS

Twenty-eight volunteers carried two HAp and one porcelain discs in their buccal sulcus for 1.5 h. Next, the discs covered with pellicle and the attached saliva film were exposed extraorally to 50 mM (pH = 3) citric acid for 2 min and unstimulated and stimulated saliva was collected. Calcium loss from HAp after erosive challenge was measured, corrected for calcium loss from pellicle on porcelain discs and averaged. Several salivary parameters were analysed. Pearson's linear correlation and multiple regression analysis were used to study the relation between saliva parameters and HAp erosion.

RESULTS

Significant correlations were found between HAp erosion and the concentration of phosphorus in unstimulated saliva (r = 0.40, p = 0.03) and between HAp erosion and the concentration of sodium (r = -0.40, p = 0.03), chloride (r = -0.47, p = 0.01), phosphorus (r = 0.45, p = 0.01) and flow (r = -0.39, p = 0.04) of stimulated saliva. Multivariate analysis revealed a significant role in the HAp erosion for sodium, urea, total protein, albumin, pH and flow of unstimulated saliva and for sodium, potassium, urea, and phosphorus of stimulated saliva.

CONCLUSIONS

Several salivary parameters are associated with the susceptibility of HAp to erosion.

Immediate implant placement: the fate of the buccal crest. A retrospective cone beam computed tomography study

This retrospective study aimed to analyse the fate of the buccal crest after immediate implant placement (IIP) through the use of cone beam computed tomography (CBCT). In 16 consecutive patients, an implant was placed in a more palatal position after extraction, thereby creating a gap of at least 2mm between the implant and the buccal crest. Subsequently, this gap was filled with a bone substitute. Preoperatively, immediate postoperatively, and late postoperatively, a CBCT was made to measure the thickness of the buccal crest. After application of the bone substitute, the buccal crest increased in thickness from 0.9mm to 2.4mm (mean). At a mean of 103 weeks after IIP, late postoperative CBCT scans showed that the thickness of the buccal crest was compacted to 1.8mm. In the same period, the height of the buccal crest increased by 1.6mm (mean) to, on average, 1.2mm above the implant shoulder. The aesthetic outcome was analysed using the White and Pink Esthetic Score (WES and PES). Both scored high: 8.4 and 11.8, respectively. Within the limitations of this study, the results of this IIP protocol are promising. Long-term prospective research on this topic on a large number of patients is necessary.

Impact of guideline implementation on patient care: a cluster RCT

In Western European countries, dentists use standardized procedures, rather than individualized risk assessment, for routine oral examinations. The predictive hypothesis was that guideline implementation strategies based on multifaceted interventions would be more effective in patient care than the dissemination of guidelines only. A cluster-randomized trial was conducted, with groups of general dental practitioners (GDPs) as the unit of randomization. Patients were clustered within practices and prospectively enrolled in the trial. Patient data were collected from registration forms. The primary outcome measure was guideline-adherent recall assignment, and a secondary outcome measure was guideline-adherent bitewing frequency. The interventions consisted of online training, guideline dissemination, and educational sessions. For low-risk patients, guideline-adherent recall increased in the intervention group (+8%), which differed from the control group (-6.1%) (p = 0.01). Guideline-adherent bitewings showed mixed results. We conclude that multifaceted intervention had a moderate but relevant effect on the performance of GDPs, which is consistent with other findings in primary care.

OUP accepted manuscript

Background

Objectives

Patients and methods

Results

Conclusions

SASOCP position statement on the pharmacist’s role in antibiotic stewardship 2018

Antibiotics are the most commonly prescribed medicines in global healthcare practice today. Their effectiveness is crucial and often life-saving in humanity’s battle against pathogens and infectious diseases. Antibiotic/antimicrobial stewardship strategies and programmes have become vital to the preservation of effective antibiotics and the optimisation of their use. The South African Society of Clinical Pharmacy (SASOCP) has written this guideline to outline the importance, role and purpose of pharmacists in such stewardship programmes, both in the public, as well as the private hospital sectors in South Africa. It also provides an overview of various approaches to antibiotic preservation, behavioural change, stewardship measures, and monitoring strategies.

Practice Guidelines for Clinical Pharmacists in Middle to Low Income Countries

The profession of pharmacy is maturing as a clinical profession in South Africa and has experienced significant development over the past 10 years. The development of clinical pharmacy in Southern Africa started in the late 1980s. The Director-General of Health and Welfare requested an expansion of the pharmacist's role in Southern Africa, in 1988, when he challenged pharmacists to be "more than just dispensers." South Africa experience human resource challenges in terms of healthcare service delivery and the shortage of pharmacists has been acknowledged. Due to the human resource shortage, it is very difficult to allocate pharmacists to work in a clinical unit on a daily basis. This document serves to set out practice guidelines for clinical pharmacy in South Africa, and to indicate areas where clinical pharmacist should concentrate to build practice.

COVID-19: Guidelines for pharmacists in South Africa

Since the outbreak of COVID-19, and its declaration as a pandemic by the World Health Organization (WHO), the reliance on pharmacists as one of the first points of contact within the healthcare system has been highlighted. This evidence-based review is aimed at providing guidance for pharmacists in community, hospital and other settings in South Africa, on the management of patients with suspected or confirmed coronavirus disease 2019, or COVID-19. The situation is rapidly evolving, and new evidence continues to emerge on a daily basis. This guidance document takes into account and includes newly available evidence and recommendations, particularly around the following aspects relating to COVID-19: EpidemiologyThe virus, its modes of transmission and incubation periodSymptom identification, including the differentiation between influenza, allergic rhinitis, sinusitis and COVID-19Social media myths and misinformationTreatment guidelines and medicines that may need to be kept in stockTreatment and prevention options, including an update on vaccine developmentThe case for and against the use of NSAIDs, ACE-inhibitors and angiotensin receptor blockers (ARBs) in patients with COVID-19Interventions and patient counselling by the pharmacist. It is critical, though, that pharmacists access the most recent and authoritative information to guide their practice. Key websites that can be relied upon are: World Health Organization (WHO): https://www.who.int/emergencies/diseases/novel-coronavirus-2019National Institute for Communicable Diseases (NICD): https://www.nicd.ac.za/diseases-a-z-index/covid-19/National Department of Health (NDoH): http://www.health.gov.za/index.php/outbreaks/145-corona-virus-outbreak/465-corona-virus-outbreak; https://sacoronavirus.co.za/.

Creating and evaluating an opportunity for medication reconciliation in the adult population of South Africa to improve patient care

OBJECTIVE

Adverse drug events (ADEs) are a major cause of morbidity and mortality, with more than 50% of ADEs being preventable. Adverse Drug Reactions (ADRs) are typically the result of an incomplete medication history, prescribing or dispensing error, as well as over- or under-use of prescribed pharmacotherapy. Medication reconciliation is the process of creating the most accurate list of medications a patient is taking and subsequently comparing the list against the different transitions of care. It is used to reduce medication discrepancies, and thereby ultimately decreasing ADEs. However, little is known about medicine reconciliation activities among public hospitals in South Africa.

METHODS

Prospective quantitative, descriptive design among Internal and Surgical wards in a leading public hospital in South Africa.

RESULTS

145 study participants were enrolled. Over 1300 (1329) medicines were reviewed of which there was a significant difference (p = 0.006) when comparing the medications that the patient was taking before or during hospitalisation. A total of 552 (41.53%) interventions were undertaken and the majority of patients had at least 3.96 medication discrepancies. The most common intervention upon admission was transcribing the home medication onto the hospital prescription (65.2%) followed by medication duplication (13.44%). During patient's hospital stay, interventions included patient counselling (32.5%) and stopping the previous treatment (37.5%).

CONCLUSION

To ensure continuity of patient care, medication reconciliation should be implemented throughout patients' hospital stay. This involves all key professionals in hospitals.

Understanding of healthcare professionals towards the roles and competencies of clinical pharmacists in South Africa

BACKGROUND

Incorporating clinical pharmacists in collaborative medical teams results in better patient treatment and health outcomes. In addition, the understanding of other healthcare professionals (HCPs) towards the role of clinical pharmacists can either facilitate or hinder the implementation and expansion of these services. The main distinction between pharmacists and clinical pharmacists lie in their different scope of duties. This study set out to explore other HCPs' understanding towards the role of the clinical pharmacists in South Africa, and to identify associated factors.

METHODS

An exploratory, survey-based, quantitative study was conducted. A survey assessing HCPs' understanding based on the competencies and role of a clinical pharmacist was distributed to 300 doctors, nurses, pharmacists and clinical pharmacists. An exploratory factor analysis was carried out to determine the construct validity of the measurement. Items were analysed for grouping into subscales through principal components analysis. Differences in the variable scores for gender, age, work experience and previous experience working with a clinical pharmacist were analyzed using independent t-tests. Analysis of variance was used to analyze differences in the variable scores for the different HCPs and the different departments of work in the hospital.

RESULTS

The factor analysis yielded two separate subscales, measuring HCPs' (n = 188) understanding towards the role of a clinical pharmacist, as well as the competencies of a clinical pharmacist. Doctors (85, n = 188) (p = 0.004) and nurses (76, n = 188) (p = 0.022), working in both surgical and non-surgical units, had significantly poorer understanding of the role of clinical pharmacists than clinical pharmacists (8, n = 188) and pharmacists (19, n = 188) (p = 0.028). Where specific clinical pharmacist activities were described, 5-16% of pharmacists were unsure whether an activity forms part of a clinical pharmacist's role. Over 50% of the clinical pharmacists disagreed that their role also includes pharmacist's activities, like stock procurement and control, pharmacy and administrative work, and hospital pharmacy-medication dispensing activities.

CONCLUSION

The findings highlighted the possible impact of role expectations and lack of understanding among HCPs. A standard job description with recognition from statutory bodies could promote other HCPs, as well as clinical pharmacists' understanding of their roles. Findings further suggested the need for interventions like interprofessional education opportunities, staff induction programmes and regular interprofessional meetings to foster acknowledgement of clinical pharmacy services, promoting the acceptance and growth of the profession.

Chronic fatigue in childhood cancer survivors is associated with lifestyle and psychosocial factors; a DCCSS LATER study

BACKGROUND

The purpose of this study was to determine factors associated with chronic fatigue (CF) in childhood cancer survivors (CCS).

PATIENTS AND METHODS

Participants were included from the Dutch Childhood Cancer Survivor Study (DCCSS) LATER cohort, a nationwide cohort of CCS (≥5 years after diagnosis) and siblings as controls. Fatigue severity was assessed with the 'fatigue severity subscale' of the Checklist Individual Strength ('CIS-fatigue'). CF was defined as scoring ≥35 on the 'CIS-fatigue' and having fatigue symptoms for ≥6 months. Twenty-four parameters were assessed, categorized into assumed fatigue triggering, maintaining and moderating factors. Multivariable logistic regression analyses were carried out to investigate the association of these factors with CF.

RESULTS

A total of 1927 CCS participated in the study (40.7% of invited cohort), of whom 23.6% reported CF (compared with 15.6% in sibling controls, P < 0.001). The following factors were associated with CF: obesity [versus healthy weight, odds ratio (OR) 1.93; 95% confidence interval (CI) 1.30-2.87], moderate physical inactivity (versus physical active, OR 2.36; 95% CI 1.67-3.34), poor sleep (yes versus no, OR 2.03; 95% CI 1.54-2.68), (sub)clinical anxiety (yes versus no, OR 1.55; 95% CI 1.10-2.19), (sub)clinical depression (yes versus no, OR 2.07; 95% CI 1.20-3.59), pain (continuous, OR 1.49; 95% CI 1.33-1.66), self-esteem (continuous, OR 0.95; 95% CI 0.92-0.98), helplessness (continuous, OR 1.13; 95% CI 1.08-1.19), social functioning (continuous, OR 0.98; 95% CI 0.97-0.99) and female sex (versus male sex, OR 1.79; 95% CI 1.36-2.37).

CONCLUSION

CF is a prevalent symptom in CCS that is associated with several assumed maintaining factors, with lifestyle and psychosocial factors being the most prominent. These are modifiable factors and may therefore be beneficial to prevent or reduce CF in CCS.

Bipolar disorder: an overview

Bipolar disorder (BD) is a chronic disorder characterised by abnormal mood changes and fluctuation in energy levels. The disease is characterised by a depressive episode, which can last up to a few months, and include low energy levels, hypersomnia, cognitive impairments, decreased sexual desire, carbohydrate craving, and weight gain. Conversely, bipolar disorder also has a stage of exhilaration and excitement, which can be classified as a manic episode. The typical presentation of these episodes of mania includes high energy hallucinations and delusions, sleep deprivation, fast speech and a constant need to be active. Risk factors that contribute to development of BD include the use of cannabis, influenza during the third trimester of pregnancy, as well as smoking during pregnancy, the use of cocaine, opioids, tranquilisers, stimulants and sedatives during pregnancy, and regular substance use during a period of a year. Parental loss before the age of five, war trauma and stress, as well as traumatic head injury may influence the condition. Clinical criteria are the mainstay of diagnosis of BD. Differentiating features, which were found to be related to BD, include early age of onset, family history, atypical features and mixed symptoms. Screening tools like the Mood Disorder Questionnaire (MDQ) and Hypomania Checklist (HCL-32) have shown the ability to differentiate BD from major depressive disorder (MDD). Treatment differs between the different phases of BD, but lithium can be considered as initial monotherapy, since it is effective against manic, depressive and mixed relapses, and has shown better evidence for prevention of new episodes. It is also associated with a reduced risk of suicide and self-harm in BD patients.

Wear behavior of a microhybrid composite vs. a nanocomposite in the treatment of severe tooth wear patients: A 5-year clinical study

OBJECTIVE

This study aimed to compare the wear behavior of a microhybrid composite vs. a nanocomposite in patients suffering from severe tooth wear.

METHODS

A convenience sample of 16 severe tooth wear patients from the Radboud Tooth Wear Project was included. Eight of them were treated with a microhybrid composite (Clearfil APX, Kuraray) and the other eight with a nanocomposite (Filtek Supreme XTE, 3M). The Direct Shaping by Occlusion (DSO) technique was used for all patients. Clinical records were collected after 1 month (baseline) as well as 1, 3 and 5 years post-treatment. The maximum height loss at specific areas per tooth was measured with Geomagic Qualify software. Intra-observer reliability was tested with paired t-tests, while multilevel logistic regression analyses were used to compare odds ratios (OR) of "large amount of wear".

RESULTS

Intra-observer reliability tests confirmed that two repeated measurements agreed well (p > 0.136). For anterior mandibular teeth, Filtek Supreme showed significantly less wear than Clearfil APX; in maxillary anterior teeth, Clearfil APX showed significantly less wear (OR _material = 0.28, OR _{jaw position} = 0.079, p < 0.001). For premolar and molar teeth, Filtek Supreme showed less wear in bearing cusps, whereas Clearfil APX showed less wear in non-bearing cusps (premolar: OR _material = 0.42, OR _{bearing condition} = 0.18, p = 0.001; molar: OR _material = 0.50, OR _{bearing condition} = 0.14, p < 0.001).

SIGNIFICANCE

Nanocomposite restorations showed significantly less wear at bearing cusps, whereas microhybrid composite restorations showed less wear at non-bearing cusps and anterior maxillary teeth.

Vitamin D supplementation in a post-pandemic era: A narrative review

Vitamin D is a fat-soluble molecule referring to the different isoforms, ergocalciferol (D2) and cholecalciferol (D3). Its physiological functions include increasing calcium serum concentrations. 25-hydroxyvitamin D3 (25(OH)D) (Calcifediol), a non-active, circulating instant precursor is seen as a pre-hormone. Studies have shown that a deficiency in calcifediol is related to chronic conditions such as cardiovascular, musculoskeletal, immune system, neurological, and anti-neoplastic functions. Vitamin D supplementation has shown its benefit as prophylaxis and treatment during the coronavirus disease 2019 (COVID-19) pandemic and an increase in the prescribing of vitamin D supplementation has been observed. The intention of this review article is to provide guidance on the recommended dosage regimen as a prophylactic measure during COVID-19 and its use as a supplement in general. From this review article, it is clear that vitamin D has an important role to play not only in COVID-19 but also in various other health aspects of the human body.Contribution: This review article highlighted the role of vitamin D in managing vitamin D deficiency and its role as a supplement in the management of respiratory tract infections, especially COVID-19. This overview can assist physicians in optimising healthcare by optimised dosing recommendations and indications.

COLISTIN: adult and paediatric guideline for South Africa, 2016

This document was created to serve as a guideline for colistin prescribing in South Africa. Antimicrobial resistance is threatening the effective prevention and treatment of a wide variety of infections, especially those that are caused by multi-drug-resistant (MDR) gram-negative bacteria. Colistin is typically used as salvage therapy, or last-line treatment, for MDR gram-negative infections. The dosing regimen should be optimised to be therapeutic and halt the emergence of resistance, whilst minimizing toxicity. This document provides evidence-based recommendations for adult and paediatric dosing, dosing in renal impairment, and the use of combination therapy to increase synergistic effects, as well as guidelines on the reconstitution and administration of colistin. This guideline is specifically aimed at healthcare workers who routinely treat patients with MDR gram-negative infections, especially in the intensive care setting.

Utility Technology in the Assessment of the Cut-Off between a Negative and a Positive Test in a Caries Prediction Model

The methodology for the assessment of a negative or positive test in caries prediction models has not received much attention. This study aims to explain how utility technology could be applied in a caries prediction model for the assessment of the cut-off between a negative and a positive test. In this study loss of utilities was assigned to false outcomes of the prediction test. A regression equation with past caries experience variables of 11-year-old children and caries increment in the 11- to 15-year forecast period as outcome was computed. The adjusted explained variance for caries increment was 0.45. Formulas were constructed for the loss of utilities for false-negative tests whereas false-positive tests were corrected with a fixed loss of utilities. Each 11-year-old child of the 252 children was screened at various points of the regression equation. Loss of utilities was calculated for each child on the basis of the validation criterion, the outcome of the test and the actual caries increment of the child. The point on the regression equation with the least loss of utilities for the whole group was taken as the cut-off between a negative and a positive test. If the validation criterion for the prediction period was set on no caries, the prediction model resulted in a sensitivity of 84% and a specificity of 73%. This prediction model has potential when caries incidence is low and resources limited.

Contextualising the Perceptions of Pharmacists Practicing Clinical Pharmacy in South Africa-Do We Practice what We Preach?

The National Department of Health published their Quality Standards for Healthcare Establishments in South Africa and introduced the National Health Insurance, with the pilot phase that commenced in 2012. The system requires an adequate supply of pharmaceutical personnel and the direct involvement of clinical pharmacists throughout the medication-use process to ensure continuity of care, minimised risk with increasing improvement of patient outcomes. The study aimed to provide insight into the pressing issues of clinical pharmacy practice in South Africa, and sets out to contextualise the current profile of the pharmacist performing clinical functions. The study used a quantitative, explorative, cross-sectional design. The population included pharmacists from private and public tertiary hospitals. A questionnaire was administered, using Typeform™. Ethics approval was obtained from Sefako Makgatho Health Sciences University, National Department of Health and Private Healthcare groups. Categorical data were summarised using frequency counts and percentages; continuous data were summarised by mean values and standard deviations. The sample size included 70 pharmacists practicing clinical pharmacy (private sector n = 59; public sector n = 11). Most participants hold a BPharm degree (busy with MPharm qualification) (64%; n = 70). No statistical significance was found between participants in private and public practice. Most pharmacist agreed (32% (private); n = 59) and strongly agreed (45% (public); n = 11) to have sufficient training to perform pharmaceutical care. The majority respondents felt that interventions made by the pharmacist improved the rational use of medicine (47% (private); 55% (public). Pharmacist interventions influence prescribing patterns (42% (private); 64% (public); and reduce polypharmacy (41% (private); 55% (public). The clinical functions mostly performed were evaluation of prescriptions (private 90%; public 82%), while the top logistical function is daily ordering of medication (40.7%; private), and checking of ward stock (36%; public). Although not all pharmacists appointed in South Africa has completed the MPharm degree in clinical pharmacy, the pharmacists at ward level perform numerous clinical functions, even if only for a small part of their workday. This paper sets the way to standardise practices of clinical pharmacy in South Africa, with a reflection on the differences in practice in different institutions.

An overview of ivabradine

This article provides an overview of the therapeutic effects of ivabradine in the treatment of coronary artery disease (CAD), and in the management of stable angina pectoris (SAP) and congestive cardiac failure (CCF). Patients with SAP have a reduced quality of life and are unable to work efficiently, resulting in the increased use of healthcare resources. Unlike the other antianginal drugs (i.e. the beta-blockers, calcium-channel blockers and organic nitrates), ivabradine specifically targets the If current of the sinus node. It reduces the frequency of angina attacks and increases the time until symptoms during work appear. Clinical evidence has shown that ivabradine is an effective anti-ischaemic and antianginal agent, comparable to the beta-blockers and calcium-channel antagonist in controlling the symptoms of myocardial ischemia.