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Fosbol E.L.,Duke Clinical Research Institute | Fosbol E.L.,Gentofte University Hospital | Peng S.A.,Outcomes Research
Circulation: Cardiovascular Quality and Outcomes | Year: 2014

Background-Prior studies have found that obese patients have paradoxically lower in-hospital mortality after non-STsegment- elevation myocardial infarction than their normal-weight counterparts, yet whether these associations persist long term is unknown. Methods and Results-We linked detailed clinical data for patients with non-ST-segment-elevation myocardial infarction aged =65 years in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) Registry to Medicare claims data to obtain longitudinal outcomes. Using height and weight measured on admission, patients were categorized into 6 body mass index (BMI [kilograms per meter squared]) groups. Multivariable Cox proportional hazards models were used to estimate the association between BMI and (1) all-cause mortality, (2) all-cause readmission, (3) cardiovascular readmission, and (4) noncardiovascular readmission for 3 years after hospital discharge. Among older patients with non-ST-segment-elevation myocardial infarction (n=34 465), 36.3% were overweight and 27.7% were obese. Obese patients were younger and more likely to have hypertension, diabetes mellitus, and dyslipidemia than normal or underweight patients. Relative to normal-weight patients, long-term mortality was lower for patients classified as overweight (BMI, 25.0-29.9), obese class I (BMI, 30.0-34.9), and obese class II (BMI, 35.0-39.9), but not obese class III (BMI =40.0). In contrast, 3-year all-cause and cardiovascular readmission were similar across BMI categories. Relative to normal-weight patients, noncardiovascular readmissions were similar for obese class I but higher for obese class II and obese class III. Conclusions-All-cause long-term mortality was generally lower for overweight and obese older patients after non-STsegment- elevation myocardial infarction relative to those with normal weight. Longitudinal readmissions were similar or higher with increasing BMI. © 2013 American Heart Association, Inc. Source

Craig B.M.,University of South Florida | Reeve B.B.,University of North Carolina at Chapel Hill | Cella D.,Northwestern University | Hays R.D.,University of California at Los Angeles | And 2 more authors.
Medical Care | Year: 2014

Background: The United States has a culturally and demographically diverse populace, and the aim of this study was to examine differences in health preferences by sex, age, ethnicity, and race. Methods: We assessed preferences for health outcomes defined by the PROMIS-29 survey in a sample of the US population. On the basis of the survey's 540 paired-comparisons trading off lifespan and 7 domains of health-related quality of life (HRQoL), we compared the choices between men and women, adults age 18-54 years and 55 years and older, Hispanics and non-Hispanics, and non-Hispanic blacks and whites. For each subgroup, we estimated the value of 122 HRQoL outcomes on a quality-adjusted life year scale and tested for subgroup differences. Results: Compared with men, women preferred reduced lifespan over losses in HRQoL, particularly for depression. Compared with the younger adults, older adults preferred reduced lifespan over the symptoms of depression, anxiety, and fatigue. Compared with non-Hispanic whites, Hispanics preferred reduced lifespan over depression and sleep disturbance, but held similar values on losses in physical functioning. Among non-Hispanics, blacks preferred reduced lifespan over losses in ability to climb stairs and to fall asleep compared with whites, but held similar values on mental health outcomes. Conclusions: With the growing emphasis on patient-centeredness and culturally sensitive treatment, it is important to recognize the diversity in values placed on potential losses in HRQoL, partieularly mental health outcomes. Demographic differences in preferences may influence comparative or cost effectiveness of treatments as perceived by one or another subgroup. Copyright © 2013 by Lippincott Williams & Wilkins. Source

Yin D.D.,Merck And Co. | Nocea G.,Outcomes Research | Qiu Y.,Merck And Co. | Mavros P.,Merck And Co.
Health and Quality of Life Outcomes | Year: 2010

Background: To evaluate the association between patient-reported hypoglycemic symptoms with ratings of their health-related quality of life state and patient-reported adverse events in patients with type 2 diabetes mellitus (T2DM).Methods: This observational, multicenter, cross sectional study was based on a sample of patients with T2DM from seven European countries who added sulfonylurea or thiazolidinedione to metformin monotherapy between January 2001 and January 2006. Included patients were required to have at least one hemoglobin A 1c(HbA 1c) measurement in the 12 months before enrollment and to not be receiving insulin. Demographic and clinical data from medical records were collected using case report forms. Questionnaires measured patient-reported hypoglycemic symptoms, health-related quality of life (EuroQol visual analogue scale, EQ-5D VAS), and treatment-related adverse events.Results: A total of 1,709 patients were included in the study. Mean patient age was 63 years, 45% were female, mean HbA 1cwas 7.06%, and 28% were at HbA 1cgoal (HbA 1c< 6.5%). Hypoglycemic symptoms during the 12 months before enrollment were reported by 38% of patients; among whom 68% reported their most severe symptoms were mild, 27% moderate, and 5% severe. Adjusted linear regression analyses revealed that patients reporting hypoglycemic symptoms had significantly lower EQ-5D VAS scores indicating worse patient-reported quality of life (mean difference -4.33, p < 0.0001). Relative to those not reporting symptoms, the adjusted decrement to quality of life increased with greater hypoglycemic symptom severity (mild: -2.68, p = 0.0039; moderate: -6.42, p < 0.0001; severe: -16.09, p < 0.0001). Patients with hypoglycemia reported significantly higher rates of shakiness, sweating, excessive fatigue, drowsiness, inability to concentrate, dizziness, hunger, asthenia, and headache (p < 0.0001 for each comparison).Conclusions: Hypoglycemic symptoms and symptom severity have an adverse effect on patients' rating of their health related quality of life state. Hypoglycemic symptoms are correlated with treatment-related adverse effects. Minimizing the risk and severity of hypoglycemia may improve patients' quality of life and clinical outcomes. Results are subject to limitations associated with observational studies including the potential biases due to unobserved patient heterogeneity and the use of a convenience sample of patients. © 2010 Alvarez-Guisasola et al; licensee BioMed Central Ltd. Source

Stjarne P.,Karolinska Institutet | Odeback P.,Skagern Primary Health Care Center | Stallberg B.,Family Medicine and Clinical Epidemiology | Lundberg J.,Outcomes Research | Olsson P.,Karolinska Institutet
Primary Care Respiratory Journal | Year: 2012

Background: Few studies have investigated the impact of acute rhinosinusitis on disease-specific quality of life, and disease costs have not been studied previously in Scandinavia. Aims: To study symptoms, treatment patterns, quality of life and costs in adults with acute rhinosinusitis. Methods: This was an observational study in primary care. Patients aged 18-80 years seeking care for acute rhinosinusitis were evaluated using the Major Symptom Score (MSS) on days 0 and 15. Recommended and used treatments, quality of life and costs were assessed by questionnaires including EQ-5D™ and a visual analogue scale (VAS) on the same days. Results: 150 patients were enrolled; 143 provided follow-up data. The proportion of MSS responders was 91%. Mean MSS decreased from 8.4 on day 0 (N=150) to 1.9 on day 15 (N=143). Patients reporting pain/discomfort and problems with usual activities decreased from 88.4% to 31.5% and from 43.2% to 1.4%, respectively, and mean VAS increased from 58.7 to 79.5. Intranasal corticosteroids were the most recommended and/or prescribed drugs. Total cost for an episode was 10,260 SEK (€1,102), of which 75% were indirect costs. Conclusions: With treatment dominated by intranasal corticosteroids, a high proportion of responders and good symptom relief were seen. Acute rhinosinusitis seems to cause a high burden on quality of life and also a high cost for society. © 2012 Primary Care Respiratory Society UK. All rights reserved. Source

Ness K.K.,St Jude Childrens Research Hospital | Armenian S.H.,Outcomes Research | Kadan-Lottick N.,Yale University | Gurney J.G.,St Jude Childrens Research Hospital
Expert Review of Hematology | Year: 2011

Survival of childhood acute lymphoblastic leukemia (ALL) is one of the greatest medical success stories of the last four decades. Unfortunately, childhood ALL survivors experience medical late effects that increase their risk of morbidity and premature death, often due to heart and vascular disease. Research has helped elucidate the mechanisms and trajectory of direct damage to the heart from treatment exposure, particularly to anthracyclines, and has also contributed knowledge on the influences of related chronic conditions, such as obesity and insulin resistance on heart health in these survivors. This article summarizes the key issues associated with early morbidity and mortality from cardiac-related disease in childhood ALL survivors and suggests directions for interventions to improve long-term outcomes. © 2011 Expert Reviews Ltd. Source

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