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Wheeler JS, Heidel RE, Dong A, Pleines KM, Hauptman PJ. Association Between Prescription Drug Discount Cards and Out-of-Pocket Costs for HFrEF Regimens. Circ Cardiovasc Qual Outcomes 2023; 16:e009987. [PMID: 37847754 DOI: 10.1161/circoutcomes.123.009987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/26/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND The burden from medication costs for treating heart failure can be financially toxic for uninsured/underinsured patients and their families. Prescription discount cards, which offer cash price reductions, may decrease out-of-pocket costs for patients without prescription benefits, but the degree to which they offer financial relief remains unclear. Our objective was to assess the financial burden for uninsured/underinsured patients prescribed a drug from each of the 4 standard classes of medications for heart failure with reduced ejection fraction. A second objective assessed whether discounts varied across economically and geographically diverse regions in Tennessee. METHODS This was a cross-sectional pricing analysis of guideline-directed medical therapy heart failure with reduced ejection fraction regimens utilizing prescription discount cards. Between February 9 and March 31, 2022, we conducted searches on 3 discount card websites (GoodRx, NeedyMeds, and Blink Health) for the prices of 30- and 90-day supplies of select guideline-directed medical therapy heart failure regimens for 6 Tennessee ZIP codes. Prices were compared with Amazon and Redbook prices. RESULTS Monthly costs among discount card services varied from $10.58 to $30.86 for a generic 3-drug regimen consisting of beta blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, and mineralocorticoid receptor antagonists. With the addition of a sodium-glucose cotransporter-2 inhibitor, prices increased to $540.32 to $593.74. The ideal 4-drug regimen (beta blocker, angiotensin receptor neprilysin inhibitor, mineralocorticoid receptor antagonist, and sodium-glucose cotransporter-2 inhibitor) ranged from $1188.31 to $1464.54. When compared with Amazon cash prices, the cards offered an average discount of 65% on a generic 3-drug regimen; when brand-name medications were added, discounts were modest (<12%). There were no significant variations in pricing based on ZIP codes in differing economic and geographic regions. CONCLUSIONS Although prescription discount cards offered significant savings on generic medications, brand-name drug discounts were small and overall costs remained high. These findings highlight the potential for unequal access to life-saving therapies for heart failure with reduced ejection fraction.
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Affiliation(s)
- James S Wheeler
- University of Tennessee College of Pharmacy, (J.S.W., A.D., K.M.P.) Knoxville, TN
| | | | - Annie Dong
- University of Tennessee College of Pharmacy, (J.S.W., A.D., K.M.P.) Knoxville, TN
| | - Katherine M Pleines
- University of Tennessee College of Pharmacy, (J.S.W., A.D., K.M.P.) Knoxville, TN
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Abstract
Background Prior research suggests an association between clinical outcomes in heart failure (HF) and social determinants of health (SDoH). Because providers should identify and address SDoH in care delivery, we evaluated how SDoH have been defined, measured, and evaluated in studies that examine HF outcomes. Methods and Results Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, databases were searched for observational or interventional studies published between 2009 and 2021 that assessed the influence of SDoH on outcomes. Selected articles were assessed for quality using a validated rating scheme. We identified 1373 unique articles for screening; 104 were selected for full-text review, and 59 met the inclusion criteria, including retrospective and prospective cohort, cross-sectional, and intervention studies. The majority examined readmissions and hospitalizations (k=33), mortality or survival (k=29), and success of medical devices and transplantation (k=8). SDoH examined most commonly included race, ethnicity, age, sex, socioeconomic status, and education or health literacy. Studies used a range of 1 to 9 SDoH as primary independent variables and 0 to 7 SDoH as controls. Multiple data sources were employed and frequently were electronic medical records linked with national surveys and disease registries. The effects of SDoH on HF outcomes were inconsistent because of the heterogeneity of data sources and SDoH constructs. Conclusions Our systematic review reveals shortcomings in measurement and deployment of SDoH variables in HF care. Validated measures need to be prospectively and intentionally collected to facilitate appropriate analysis, reporting, and replication of data across studies and inform the design of appropriate, evidence-based interventions that can ameliorate significant HF morbidity and societal costs.
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Affiliation(s)
- Kimberly R. Enard
- College for Public Health and Social JusticeSaint Louis UniversitySaint LouisMO
| | - Alyssa M. Coleman
- College for Public Health and Social JusticeSaint Louis UniversitySaint LouisMO
| | - R. Aver Yakubu
- College for Public Health and Social JusticeSaint Louis UniversitySaint LouisMO
| | | | - Donghua Tao
- Medical Center LibrarySaint Louis UniversitySaint LouisMO
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Edwards JC, Mosman A, Hauptman PJ, Lee T, Philipneri M, Farahmand F, Yn L, Brandon M, Buchanan PM. Arrhythmia in chronic hemodialysis as a function of predialysis electrolytes and interdialytic interval. Hemodial Int 2023; 27:45-54. [PMID: 36411729 DOI: 10.1111/hdi.13057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/19/2022] [Accepted: 11/07/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION People with end-stage renal disease on hemodialysis are at increased risk for death due to arrhythmia associated with the prolonged interdialytic interval that typically spans the weekend, with bradycardia being the arrhythmia most closely associated with sudden death. In this prospective observational study we assessed whether predialysis fluid and electrolytes values including hyperkalemia are risk factors for the arrhythmias associated with the prolonged interdialytic interval. METHODS Sixty patients on hemodialysis with a history of hyperkalemia underwent cardiac monitoring for 1 week. Arrhythmia frequency, average QTc interval, and average root mean square of successive differences (rMSSD) per 4-h period were reported. Predialysis electrolytes and electrocardiograms were collected prior to pre- and post-weekend dialysis sessions. Clinical variables were assessed for correlation with arrhythmias. FINDINGS Predialysis hyperkalemia occurred in 29 subjects and was more common at the post-weekend dialysis session. Bradycardia occurred in 11 subjects and increased before and during the post-weekend dialysis session, but was not correlated with any electrolyte or clinical parameter. Ventricular ectopy occurred in 50 subjects with diurnal variation unrelated to dialysis. Pre-dialysis prolonged QTc was common and not affected by interdialytic interval. Average QTc increased and rMSSD decreased during dialysis sessions and were not correlated with clinical parameters. DISCUSSION The results confirm that arrhythmias are prevalent in dialysis subjects with bradycardia particularly associated with the longer interdialytic interval; EKG markers of arrhythmia risk are increased during dialysis independent of interdialytic interval. Larger sample size and/or longer recording may be necessary to identify the clinical parameters responsible.
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Affiliation(s)
- John C Edwards
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Amy Mosman
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Paul J Hauptman
- Reno School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Taewoo Lee
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Marie Philipneri
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Firoozeh Farahmand
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Louis Yn
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Margaret Brandon
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Paula M Buchanan
- AHEAD Institute, Department of Health and Clinical Outcomes Research Saint Louis University, Saint Louis, Missouri, USA
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Kapelios CJ, Lund LH, Benson L, Dahlström U, Rosano GMC, Hauptman PJ, Savarese G. Digoxin use in contemporary heart failure with reduced ejection fraction: an analysis from the Swedish Heart Failure Registry. Eur Heart J Cardiovasc Pharmacother 2021; 8:756-767. [PMID: 34921603 PMCID: PMC9716867 DOI: 10.1093/ehjcvp/pvab079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/05/2021] [Accepted: 11/17/2021] [Indexed: 02/07/2023]
Abstract
AIMS Digoxin is included in some heart failure (HF) guidelines but controversy persists about the true role for and impact of treatment with this drug, particularly in the absence of atrial fibrillation (AF). The aim of this study was to assess the association between clinical characteristics and digoxin use and between digoxin use and mortality/morbidity in a large, contemporary cohort of patients with HF with reduced ejection fraction (HFrEF) stratified by history of AF. METHODS AND RESULTS Patients with HFrEF (EF < 40%) enrolled in the Swedish HF registry between 2005 and 2018 were analysed. The independent association between digoxin use and patient characteristics was assessed by logistic regression, and between digoxin use and outcomes [composite of all-cause mortality or HF hospitalization (HFH), all-cause mortality, and HFH] by Cox regressions in a 1:1 propensity score matched population. Digoxin use was analysed at baseline and as a time-dependent variable. Of 42 456 patients with HFrEF, 16% received digoxin, 29% in the AF group and 2.8% in the non-AF group. The main independent predictors of use were advanced HF, higher heart rate, history of AF, preserved renal function, and concomitant use of beta blockers. Digoxin use was associated with lower risk of all-cause death/HFH [hazard ratio (HR): 0.95; 95% confidence interval (CI): 0.91-0.99] in AF, but with higher risk in non-AF (HR: 1.24; 95% CI: 1.09-1.43). Consistent results were observed when digoxin use was analysed as a time-dependent variable. CONCLUSION The great majority of digoxin users had a history of AF. Digoxin use was associated with lower mortality/morbidity in patients with AF, but with higher mortality/morbidity in patients without AF.
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Affiliation(s)
- Chris J Kapelios
- Cardiology Department, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Lina Benson
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Dahlström
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Giuseppe M C Rosano
- Cardiovascular Clinical Academic Group, St George's Hospitals NHS Trust, University of London, Cranmer Terrace, London, UK,IRCCS San Raffaele, Pisana, Roma, Italy
| | - Paul J Hauptman
- Graduate School of Medicine, University of Tennessee, Knoxville, TN, USA
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5
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Affiliation(s)
- Paul J Hauptman
- University of Tennessee Graduate School of Medicine, Knoxville TN.
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Greene SJ, Adusumalli S, Albert NM, Hauptman PJ, Rich MW, Heidenreich PA, Butler J. Building a Heart Failure Clinic: A Practical Guide from the Heart Failure Society of America. J Card Fail 2020; 27:2-19. [PMID: 33289664 DOI: 10.1016/j.cardfail.2020.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/13/2020] [Indexed: 01/09/2023]
Abstract
Heart failure (HF) remains a leading cause of mortality and morbidity and a primary driver of health care resource use in the United States. As such, there continues to be much interest in the development and refinement of HF clinics that manage patients with HF in a guideline-directed, technology-enabled, and coordinated approach. Optimization of resource use and maintenance of collaboration with other providers are also important themes when considering implementation of HF clinics. Through this document, the Heart Failure Society of America aims to provide a contemporary, practical guide to creating and sustaining a HF clinic. The guide discusses (1) patient care considerations for delivering guideline-directed and patient-centered care, and (2) operational considerations including development of a HF clinic business plan, setting goals, leadership support, triggers for patient referral and patient follow-up, patient population served, optimal clinic staffing models, relationships with subspecialists, and continuous quality improvement. This document was developed to empower providers and clinicians who wish to build and sustain community-based, successful HF clinics.
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Affiliation(s)
- Stephen J Greene
- Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Srinath Adusumalli
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nancy M Albert
- Nursing Institute and Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio USA
| | - Paul J Hauptman
- University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Michael W Rich
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Javed Butler
- University of Mississippi Medical Center, Jackson, Mississippi, USA.
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7
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Goff ZD, Heidel RE, Grabeel K, Hauptman PJ. Roadblocks For Patients with Heart Failure Navigating Clinicaltrials.gov. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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8
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Hauptman PJ, Piña IL. The New Kids on the Block: Don't Delay. J Card Fail 2020; 26:811-812. [DOI: 10.1016/j.cardfail.2020.09.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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9
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Goff ZD, Eric Heidel R, Hauptman PJ. Is ClinicalTrials.gov Searchable for Patients With Heart Failure? J Card Fail 2020; 27:120-122. [PMID: 32991983 DOI: 10.1016/j.cardfail.2020.09.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Zackary D Goff
- Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - R Eric Heidel
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Paul J Hauptman
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
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Kichura AB, Duderija E, Vidic A, Hoerner RM, Bhandari V, Byrne LE, Patel KK, Chibnall JT, Hauptman PJ. Does a brief functional assessment in the emergency department predict outcomes of patients admitted with heart failure? The FASTER-HF study. Arch Cardiovasc Dis 2020; 113:766-771. [PMID: 32943373 DOI: 10.1016/j.acvd.2020.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/28/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evaluation of patients with acute decompensated heart failure includes symptom review, biomarker measurement and comorbidity assessment. Early objective evaluation of functional status is generally not performed. AIM To investigate whether a simple low-impact functional assessment and measurement of sarcopenia would be safe, feasible and predictive of hospital length of stay and all-cause 30-day hospital readmission. METHODS We administered 3-minute bicycle ergometry and hand grip strength tests at admission and discharge to patients for whom a decision to admit for heart failure management was made in the emergency department. Associations were examined between test results and length of stay and 30-day readmission. Exclusion criteria included acute coronary syndrome, hypoxia, end-stage renal disease, dementia/delirium and inability to sit at bedside. The Kansas City Cardiomyopathy Questionnaire-12, the Patient Health Questionnaire-2 and the visual analogue scale for dyspnoea were administered at admission, the visual analogue scale at discharge and the Kansas City Cardiomyopathy Questionnaire-12 at 30 days. RESULTS Fifty patients were enrolled: 58% were female; the mean age was 66.2±12.5 years; 24% had heart failure with preserved ejection fraction. Bicycle ergometry variables did not correlate with outcomes. Change in handgrip strength correlated with readmission, but not after adjustment (rpartial=0.14; P=0.35). Total diuretic dose correlated with length of stay; only discharge visual analogue scale and baseline lung disease had significant adjusted correlations with readmission. CONCLUSIONS Functional assessment in the emergency department of patients admitted for heart failure did not predict outcomes. However, the prognostic value of these assessments for decision-making about disposition (admission or discharge) may still be warranted.
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Affiliation(s)
- Andrew B Kichura
- Department of Medicine, Saint-Louis University School of Medicine, 63110 St.-Louis, MO, USA
| | - Eldin Duderija
- Department of Medicine, Saint-Louis University School of Medicine, 63110 St.-Louis, MO, USA
| | - Andrija Vidic
- Department of Medicine, Saint-Louis University School of Medicine, 63110 St.-Louis, MO, USA
| | - Robert M Hoerner
- Department of Medicine, Saint-Louis University School of Medicine, 63110 St.-Louis, MO, USA
| | - Vindeep Bhandari
- Department of Medicine, Saint-Louis University School of Medicine, 63110 St.-Louis, MO, USA
| | - Laurie E Byrne
- Department of Surgery-Emergency Medicine, Saint-Louis University School of Medicine, 63110 St.-Louis, MO, USA
| | - Keval K Patel
- Department of Medicine, Saint-Louis University School of Medicine, 63110 St.-Louis, MO, USA
| | - John T Chibnall
- Department of Psychiatry & Behavioural Neuroscience, Saint-Louis University School of Medicine, 63110 St.-Louis, MO, USA
| | - Paul J Hauptman
- Department of Medicine, Saint-Louis University School of Medicine, 63110 St.-Louis, MO, USA.
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11
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Hauptman PJ, Wall JS, Maurer MS. Disparities, Uncertainties, and Societal Cost: Precision Medicine and Transthyretin Amyloidosis. Am J Med 2020; 133:892-894. [PMID: 32268147 DOI: 10.1016/j.amjmed.2020.02.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/14/2020] [Accepted: 02/16/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Paul J Hauptman
- University of Tennessee Graduate School of Medicine, Knoxville Tenn.
| | - Jonathan S Wall
- University of Tennessee Graduate School of Medicine, Knoxville Tenn
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12
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Hauptman PJ. Cardiac Effects of Music and a Presidential Impeachment. J Card Fail 2020; 26:539-540. [DOI: 10.1016/j.cardfail.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
| | - Paul J Hauptman
- University of Tennessee Graduate School of Medicine, Knoxville, TN
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14
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Affiliation(s)
- Kimberly R Enard
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri
| | - Paul J Hauptman
- University of Tennessee Graduate School of Medicine, Knoxville
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Affiliation(s)
- Paul J Hauptman
- University of Tennessee Graduate School of Medicine (Knoxville TN) and the Cardiovascular Division, Washington University School of Medicine (St. Louis MO).
| | - Michael W Rich
- University of Tennessee Graduate School of Medicine (Knoxville TN) and the Cardiovascular Division, Washington University School of Medicine (St. Louis MO)
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Hauptman PJ, Rich MW. Read, Cite, Submit and Repeat! J Card Fail 2020; 26:1. [DOI: 10.1016/j.cardfail.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hauptman PJ, Rich MW. A New Home for Innovation. J Card Fail 2019; 25:853. [PMID: 31761150 DOI: 10.1016/j.cardfail.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Paul J Hauptman
- University of Tennessee Graduate School of Medicine, Knoxville TN, 1924 Alcoa Highway, Knoxville TN 37924, 865 305 9290.
| | - Michael W Rich
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
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Munigala S, Brandon M, Goff ZD, Sagall R, Hauptman PJ. Drug discount cards in an era of higher prescription drug prices: A retrospective population-based study. J Am Pharm Assoc (2003) 2019; 59:804-808.e1. [PMID: 31422026 DOI: 10.1016/j.japh.2019.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/30/2019] [Accepted: 05/21/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Drug discount programs have emerged as a potential option for patients seeking greater accessibility and affordability. However, there is limited knowledge regarding program utilization and cost savings. The objective of this study was to evaluate medication prescriptions with drug discount card usage and estimate cost savings. DESIGN Retrospective study. SETTING AND PARTICIPANTS Using population-based prescription data, the study included patients who filled prescriptions from January 2009 to December 2016 nationwide using NeedyMeds.org drug discount cards. OUTCOME MEASURES We determined the frequency of drug discount card prescriptions (across pharmacy types, pharmacy location, and prescriber specialty), estimated cost savings using the drug discount card (average per drug discount card and total program dollars saved) and evaluated the top prescription drugs by frequency. RESULTS A total of 4,638,581 prescriptions with discount cards were identified (79.8% at national, 6.3% at regional, and 12.9% at local pharmacies). Most were filled at urban locations (urban clusters, 88.6%; urbanized areas, 8.4%) and in ZIP codes with lower median household incomes (62.7%). Overall, 3.62 million prescriptions (78.0% of the total) were associated with discounts, resulting in a total savings of $199,183,112 (median cost savings, $17.80 [47.8%] per prescription). Opiates were the most common class of drugs for which discount cards were used. CONCLUSION The use of a drug discount program over 8 years resulted in total savings of nearly $200 million (approximately $18 per prescription) compared with the original cost. However, although patients might accrue financial benefit, there is still a lack of price transparency. Additional research is needed to better understand the impact of these programs and to evaluate ways to improve medication access at a reasonable cost to patients.
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Hauptman PJ, Rich MW. What's In Your Meeting? J Card Fail 2019; 25:583. [DOI: 10.1016/j.cardfail.2019.07.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 11/24/2022]
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Bounthavong M, Butler J, Dolan CM, Dunn JD, Fisher KA, Oestreicher N, Pitt B, Hauptman PJ, Veenstra DL. Correction to: Cost-Effectiveness Analysis of Patiromer and Spironolactone Therapy in Heart Failure Patients with Hyperkalemia. Pharmacoeconomics 2019; 37:1071. [PMID: 31089966 PMCID: PMC6830401 DOI: 10.1007/s40273-019-00809-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Correction to Bounthavong M, Butler J, Dolan CM, Dunn JD, Fisher KA, Oestreicher N, Pitt B, Hauptman PJ, Veenstra DL.
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Affiliation(s)
- Mark Bounthavong
- Department of Pharmacy, University of Washington, 1959 NE Pacific St, HSB H375-P, Box 357630, Seattle, WA, 98195-7630, USA
| | - Javed Butler
- Division of Cardiology, Stony Brook University, Stony Brook, NY, USA
| | | | | | | | - Nina Oestreicher
- Epidemiology, HEOR and Observational Research, Relypsa, Inc., a Vifor Pharma Group Company, Redwood City, CA, USA
- Department of Clinical Pharmacy, University of California, San Francisco, CA, USA
| | - Bertram Pitt
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Paul J Hauptman
- Division of Cardiology, Department of Medicine, Saint Louis University School of Medicine, Saint Louis, MI, USA
| | - David L Veenstra
- Department of Pharmacy, University of Washington, 1959 NE Pacific St, HSB H375-P, Box 357630, Seattle, WA, 98195-7630, USA.
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Hauptman PJ. How Much Validation Do We Need? J Card Fail 2019; 25:493. [PMID: 31345282 DOI: 10.1016/j.cardfail.2019.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Paul J Hauptman
- University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN 37920. Tel.: 865 305 9290.
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Hauptman PJ, Rich MW. Noise Pollution is the Heart Failure Community's Biggest Threat. J Card Fail 2019; 25:225-226. [PMID: 30979381 DOI: 10.1016/j.cardfail.2019.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Paul J Hauptman
- University of Tennessee Graduate School of Medicine, Knoxville TN and Washington University, St. Louis MO.
| | - Michael W Rich
- University of Tennessee Graduate School of Medicine, Knoxville TN and Washington University, St. Louis MO
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Affiliation(s)
- Eiran Z Gorodeski
- Section of Heart Failure and Cardiac Transplant Medicine, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH; Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
| | - Michael W Rich
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Paul J Hauptman
- Department of Medicine, Saint Louis University School of Medicine, St Louis, MO
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25
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Hauptman PJ. Is Heart Failure a High Tech Industrial Giant? J Card Fail 2018; 24:721-722. [PMID: 30501995 DOI: 10.1016/j.cardfail.2018.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Paul J Hauptman
- University of Tennessee Graduate School of Medicine, Knoxville TN.
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Bounthavong M, Butler J, Dolan CM, Dunn JD, Fisher KA, Oestreicher N, Pitt B, Hauptman PJ, Veenstra DL. Cost-Effectiveness Analysis of Patiromer and Spironolactone Therapy in Heart Failure Patients with Hyperkalemia. Pharmacoeconomics 2018; 36:1463-1473. [PMID: 30194623 PMCID: PMC6244629 DOI: 10.1007/s40273-018-0709-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Certain patients with heart failure (HF) are unable to tolerate spironolactone therapy due to hyperkalemia. Patiromer is a novel agent used to treat hyperkalemia and has been shown to be efficacious, safe, and well-tolerated. The potential clinical outcomes and economic value of using patiromer and spironolactone in patients with HF unable to otherwise tolerate spironolactone due to hyperkalemia are unclear. The objective of this analysis was to model the potential pharmacoeconomic value of using patiromer and spironolactone in patients with a history of hyperkalemia that prevents them from utilizing spironolactone. METHODS We performed a cost-effectiveness analysis of treatment with patiromer, spironolactone, and an angiotensin-converting enzyme inhibitor (ACEI) in patients with New York Heart Association (NYHA) class III-IV HF compared with ACEI alone. A Markov model was constructed to simulate a cohort of 65-year-old patients diagnosed with HF from the payer perspective across the lifetime horizon. Clinical inputs were derived from the RALES and OPAL-HK randomized trials of spironolactone and patiromer, respectively. Utility estimates and costs were derived from the literature and list prices. Outcomes assessed included hospitalization, life expectancy, and quality-adjusted life-years (QALYs), costs, and the incremental cost-effectiveness ratio (ICER). One-way and probability sensitivity analyses were performed to test the robustness of the model findings. RESULTS Treatment with patiromer-spironolactone-ACEI was projected to increase longevity compared with ACEI alone (5.29 vs. 4.62 life-years gained, respectively), greater QALYs (2.79 vs. 2.60), and costs (US$28,200 vs. US$18,200), giving an ICER of US$52,700 per QALY gained. The ICERs ranged from US$40,000 to US$85,800 per QALY gained in 1-way sensitivity analyses. CONCLUSION Our results suggest that the use of spironolactone-patiromer-ACEI may provide clinical benefit and good economic value in patients with NYHA class III-IV HF unable to tolerate spironolactone due to hyperkalemia.
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Affiliation(s)
- Mark Bounthavong
- Department of Pharmacy, University of Washington, 1959 NE Pacific St, HSB H375-P, Box 357630, Seattle, WA, 98195-7630, USA
| | - Javed Butler
- Division of Cardiology, Stony Brook University, Stony Brook, NY, USA
| | | | | | | | - Nina Oestreicher
- Epidemiology, HEOR and Observational Research, Relypsa, Inc., a Vifor Pharma Group Company, Redwood City, CA, USA
- Department of Clinical Pharmacy, University of California, San Francisco, CA, USA
| | - Bertram Pitt
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Paul J Hauptman
- Division of Cardiology, Department of Medicine, Saint Louis University School of Medicine, Saint Louis, MI, USA
| | - David L Veenstra
- Department of Pharmacy, University of Washington, 1959 NE Pacific St, HSB H375-P, Box 357630, Seattle, WA, 98195-7630, USA.
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Vidic A, Shuster JE, Goff ZD, Godishala A, Joseph SM, Chibnall JT, Hauptman PJ. Vasopressin antagonism for decompensated right-sided heart failure. Int J Cardiol 2018; 274:245-247. [PMID: 30193794 DOI: 10.1016/j.ijcard.2018.08.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/16/2018] [Accepted: 08/09/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Targeted treatment for decompensated right heart failure (RHF) with or without left heart failure is lacking. Vasopressin antagonists (vaptans) may offer an option by increasing urine output and fluid mobilization when used in acute decompensated RHF without impacting blood pressure or renal function, both common complications of loop diuretics. METHODS AND RESULTS We searched electronic medical records from 2 institutions over 4 years for patients with RHF treated with vaptans. Urine output, creatinine, BUN and sodium, 1 day pre- versus 1 day post-vaptan initiation were compared. Baseline (admission) pre-vaptan values for patients with RHF who met inclusion criteria (n = 112) were RAP, median (interquartile range) = 19 (13-24) mmHg; cardiac index, mean ± standard deviation = 1.8 ± 0.4 L/min/m2; BNP, 1078 (523-1690) pg/ml; creatinine clearance of 51 (39-69) ml/min, BUN, 37 (26-54) mg/dl, and serum [Na+] 132 (126-135) mEq/L. Most patients (n = 103/112) received intravenous inotrope (prior to vaptan, n = 91). Overall length of stay was 27 (16-43) days. Vaptan treatment (90% tolvaptan, 10% conivaptan) was associated with increased 24 h urine output, 1517 (906-2394) vs 2337 (1425-3744) mL, p = 0.005, and [Na+], 127 (124-130) vs 130 (126-135) mEq/L, p = 0.001, without significant change in Cr or BUN. Furosemide IV dose equivalent decreased or remained unchanged in 75% of patients at 24 h and 64% at 72 h compared to the 24 h prior to vaptan use. CONCLUSION Vaptans were associated with a significant increase in urine output and serum sodium with an apparent reduction or stabilization of furosemide equivalent dosing in the early treatment period in patients with decompensated RHF. Vaptans may offer a management option for patients failing conventional diuretic-based treatment.
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Affiliation(s)
- Andrija Vidic
- The Department of Medicine, Florida Hospital, Orlando, FL, United States of America
| | - Jerrica E Shuster
- The Department of Pharmacy, Barnes Jewish Hospital, St. Louis, MO, United States of America
| | - Zackary D Goff
- The Department of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Anuradha Godishala
- The Department of Medicine, Barnes Jewish Hospital, St. Louis, MO, United States of America
| | - Susan M Joseph
- The Department of Medicine, Baylor University, Dallas, TX, United States America
| | - John T Chibnall
- The Department of Medicine, Saint Louis University, St. Louis, MO, United States of America
| | - Paul J Hauptman
- The Department of Medicine, Saint Louis University, St. Louis, MO, United States of America.
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Munigala S, Brandon M, Goff ZD, Sagall R, Hauptman PJ. Evaluation of Heart Failure Medication Prescriptions using an Online Drug Discount Program. J Card Fail 2018. [DOI: 10.1016/j.cardfail.2018.07.319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hauptman PJ. The Importance of Using Correct Terms. J Card Fail 2018; 24:347-348. [DOI: 10.1016/j.cardfail.2018.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Buch V, Ralph H, Salas J, Hauptman PJ, Davis D, Scherrer JF. Chest Pain, Atherosclerotic Cardiovascular Disease Risk, and Cardiology Referral in Primary Care. J Prim Care Community Health 2018; 9:2150132718773259. [PMID: 29756524 PMCID: PMC5954572 DOI: 10.1177/2150132718773259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: The atherosclerotic cardiovascular disease (ASCVD) 10-year risk estimate is recommended by cardiologists for determining risk of a cardiac event. However, the majority of patients presenting to primary care with chest pain have noncardiac etiologies. Therefore, we determined if high versus low ASCVD risk was associated with primary care physicians’ referral to cardiology in patients with and without chest pain. Methods: Deidentified electronic health record (EHR) data was obtained from 5795 patients treated in academic primary care clinics from 2008 to 2015. Referral to cardiology was defined by an EHR code, chest pain was defined by ICD-9-CM code (786.5) and ASCVD was modeled as high versus low risk. Separate logistic regression models were computed to estimate the association between chest pain and referral to cardiology, ASCVD risk and referral, and both chest pain and ASCVD risk and referral with adjustment for potential confounding factors. Results: More patients with (n = 95, 7.8%) versus without (n = 75, 2.0%) chest pain were referred to cardiology (P < .0001). Separate unadjusted models revealed chest pain and high versus low ASCVD risk were significantly associated with referral (odds ratio [OR] = 4.20; 95% confidence interval [CI] 3.07-5.73 and OR = 1.41; 95% CI 1.04-1.91, respectively). After adjusting for ASCVD risk and confounders, chest pain but not high ASCVD risk remained significantly associated with referral (OR = 1.75; 95% CI 1.24-2.47 and OR = 1.15; 95% CI 0.72-1.82, respectively). Conclusions: In primary care patients presenting with chest pain, ASCVD risk scores are not associated with referral to cardiology. Overall, less than 8% of patients with chest pain were referred. While there is no evidence to indicate excessive referral to cardiology, we posit that implementing ASCVD risk tools in decision aids could contribute to referring those most in need of cardiology care.
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Affiliation(s)
- Vishaal Buch
- 1 Saint Louis University School of Medicine, St Louis, MO, USA
| | - Hayley Ralph
- 1 Saint Louis University School of Medicine, St Louis, MO, USA
| | - Joanne Salas
- 1 Saint Louis University School of Medicine, St Louis, MO, USA
| | - Paul J Hauptman
- 1 Saint Louis University School of Medicine, St Louis, MO, USA
| | - Dawn Davis
- 1 Saint Louis University School of Medicine, St Louis, MO, USA
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Hauptman PJ. Defining RTUs and RRUs for Heart Failure Care. J Card Fail 2018; 24:207-208. [PMID: 29606328 DOI: 10.1016/j.cardfail.2018.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Paul J Hauptman
- Department of Medicine (Cardiology), Saint Louis University School of Medicine, St. Louis, Missouri.
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Munigala S, Brandon M, Goff ZD, Sagall R, Hauptman PJ. Abstract 232: Medication Cost Savings Using an On-line Drug Discount Program. Circ Cardiovasc Qual Outcomes 2018. [DOI: 10.1161/circoutcomes.11.suppl_1.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
To evaluate the frequency of drug discount card utilization and to estimate cost savings associated with heart failure (HF) medication prescriptions.
Methods:
We conducted a retrospective study of all HF prescriptions filled through the NeedyMeds.org drug discount card program nationwide, from January 2009 to December 2016. We evaluated the frequency of drug discount card prescriptions (across pharmacy types, pharmacy location, by prescriber specialty and by drug class) and calculated cost savings (average per drug discount card and total program dollars saved) for entire study period and for each year (from 2009 to 2016).
Findings:
A total of 381,347 prescriptions for medications that can be used for HF with drug discount cards were identified during the study period (83.7% at national, 5.7% at regional and 9.8% at local pharmacies). Most prescriptions were filled at urban locations (89.1% in urban clusters, 7.6% in urbanized areas) and in ZIP-codes with lower median household income (65.5%). Angiotensin-converting enzyme inhibitors and selected angiotensin receptor blockers were the most prescribed drugs with discount cards (44.1%) followed by beta blockers (27.5%), diuretics (21.5%), and mineralocorticoid receptor agonists (3.9%). The number of HF prescriptions with drug discount cards increased from 2577 in 2009 to 64,750 in 2016. Increase in the number of prescriptions was also noted for all drug classes from 2009 to 2016. Overall 224,049 prescriptions for HF medications (59% of the total) benefited from the program resulting in total savings of $4,739,204 with a median cost saving of $9.30 (41.5%) per prescription.
Conclusion:
Use of a drug discount program resulted in cost savings on HF prescription medications (approximately $9 in savings per prescription) compared to the original cost charged by pharmacies. While these drug assistance programs may reduce financial burden, continued efforts should be made to improve adherence to medications and for better outcomes.
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Affiliation(s)
- Paul J Hauptman
- Department of Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - Richard J Bookman
- Department of Molecular and Cellular Pharmacology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Stephen Heinig
- Association of American Medical Colleges, Washington, DC
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Hauptman PJ. The Barber, the Tell, and the Teapot. J Card Fail 2017; 23:717-718. [DOI: 10.1016/j.cardfail.2017.08.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Goff ZD, Kichura AB, Chibnall JT, Hauptman PJ. A Survey of Unregulated Direct-to-Consumer Treatment Centers Providing Stem Cells for Patients With Heart Failure. JAMA Intern Med 2017; 177:1387-1388. [PMID: 28738122 PMCID: PMC5818832 DOI: 10.1001/jamainternmed.2017.2988] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study used a telephone survey to assess the type of treatment, cost, and statements made about efficacy at unregulated stem cell centers.
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Affiliation(s)
- Zackary D Goff
- Department of Medicine-Cardiology, Saint Louis University School of Medicine, St Louis, Missouri
| | - Andrew B Kichura
- Department of Medicine-Cardiology, Saint Louis University School of Medicine, St Louis, Missouri
| | - John T Chibnall
- Department of Psychiatry, Saint Louis University School of Medicine, St Louis, Missouri
| | - Paul J Hauptman
- Department of Medicine-Cardiology, Saint Louis University School of Medicine, St Louis, Missouri
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Hauptman PJ. Henry and Mount Rushmore. J Card Fail 2017; 23:657-658. [DOI: 10.1016/j.cardfail.2017.07.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dunlap ME, Hauptman PJ, Amin AN, Chase SL, Chiodo JA, Chiong JR, Dasta JF. Current Management of Hyponatremia in Acute Heart Failure: A Report From the Hyponatremia Registry for Patients With Euvolemic and Hypervolemic Hyponatremia (HN Registry). J Am Heart Assoc 2017; 6:JAHA.116.005261. [PMID: 28775063 PMCID: PMC5586406 DOI: 10.1161/jaha.116.005261] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Hyponatremia (HN) occurs commonly in patients with acute heart failure and confers a worse prognosis. Current HN treatment varies widely, with no consensus. This study recorded treatment practices currently used for patients hospitalized with acute heart failure and HN. Methods and Results Data were collected prospectively from 146 US sites on patients hospitalized with acute heart failure and HN (serum sodium concentration [Na+] ≤130 mEq/L) present at admission or developing in the hospital. Baseline variables, HN treatment, and laboratory values were recorded. Of 762 patients, median [Na+] was 126 mEq/L (interquartile range, 7) at baseline and increased to 130 mEq/L at discharge. Fluid restriction was the most commonly prescribed therapy (44%), followed by no specific HN treatment beyond therapy for congestion (23%), isotonic saline (5%), tolvaptan (4%), and hypertonic saline (2%). Median rate of change in [Na+] varied by treatment (0.5 [interquartile range, 1.0] to 2.3 [8.0] mEq/L/d) and median treatment duration ranged from 1 (interquartile range, 1) to 6 (5) days. Fluid restriction and no specific HN treatment resulted in similar changes in [Na+], and were least effective in correcting HN. Few patients (19%) had [Na+] ≥135 mEq/L at discharge. Conclusions The most commonly used treatment approaches for HN (fluid restriction and no specific treatment) in acute heart failure increased [Na+] minimally, and most patients remained hyponatremic at discharge.
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Affiliation(s)
- Mark E Dunlap
- MetroHealth Campus of Case Western Reserve University, Cleveland, OH
| | | | | | - Sandra L Chase
- Otsuka Product Development & Commercialization, Inc.,, Princeton, NJ
| | - Joseph A Chiodo
- Otsuka Product Development & Commercialization, Inc.,, Princeton, NJ
| | - Jun R Chiong
- Loma Linda University Medical Center, Loma Linda, CA
| | - Joseph F Dasta
- The University of Texas at Austin College of Pharmacy, Hutto, TX
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Vidic A, Goff ZD, Godishala A, Shuster JE, Joseph SM, Chibnall JT, Hauptman PJ. Vasopressin Antagonism for Severe Decompensated Right-Sided Heart Failure: Time for Critical Study? J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Goff ZD, Kichura AB, Chibnall JT, Hauptman PJ. Stem Cells for Heart Failure: A Survey of Unregulated Direct-to-Consumer Treatment Centers. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Affiliation(s)
- Paul J Hauptman
- From the Department of Medicine (Cardiology), Saint Louis University School of Medicine, St. Louis
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Affiliation(s)
- Tien M. H. Ng
- School of Pharmacy and Keck School of Medicine, University of Southern California, Los Angeles
| | - Rishi Menon
- Department of Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - Paul J. Hauptman
- Department of Medicine, Saint Louis University School of Medicine, St Louis, Missouri
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Dean CA, Arnold LD, Hauptman PJ, Wang J, Elder K. Patient, Physician, and Practice Characteristics Associated with Cardiovascular Disease Preventive Care for Women. J Womens Health (Larchmt) 2017; 26:491-499. [PMID: 28437218 DOI: 10.1089/jwh.2015.5613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death for American women. Although CVD preventive care has the potential to reduce a significant number of these deaths, the degree to which healthcare providers deliver such care is unknown. The purpose of this study was to identify patient, physician, and practice characteristics that significantly influence the provision of CVD preventive care during ambulatory care visits for female patients. METHODS The National Ambulatory Medical Care Survey datasets from 2005 to 2010 were utilized. The study sample included female patients ≥20 years of age whose healthcare provider performed CVD preventive care and who had visits for a new health problem, a routine chronic problem, management of a chronic condition, and preventive care. Binary logistic regression models estimated the association of patient, physician, and practice characteristics and CVD preventive care; cholesterol testing, body mass index (BMI) screening, and tobacco education. RESULTS Of the 32,009 visits, 15.9% involved cholesterol testing, 50.3% involved BMI screening, and 3.20% involved tobacco education. Obstetricians/gynecologists were less likely to perform cholesterol testing (aOR: 0.39; 95% CI: 0.25-0.61) and tobacco education (aOR: 0.56; 95% CI: 0.32-0.98) than general/family physicians. CONCLUSION The delivery of CVD preventive care varied by healthcare provider type, with obstetricians/gynecologists having lower odds of providing two of the three services. The amount of time a physician spent with a patient was a significant predictor for the provision of all three services. These findings demonstrate the need to implement multifaceted approaches to address predicting characteristics of CVD preventive care.
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Affiliation(s)
- Caress A Dean
- 1 Master of Public Health Program, School of Health Sciences, Oakland University , Rochester, Michigan
| | - Lauren D Arnold
- 2 Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University , St. Louis, Missouri
| | - Paul J Hauptman
- 3 Division of Cardiology, Saint Louis University School of Medicine, Saint Louis University Hospital , St. Louis, Missouri
| | - Jing Wang
- 4 Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University , St. Louis, Missouri
| | - Keith Elder
- 5 School of Public Health, Samford University , Birmingham, Alabama
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Affiliation(s)
- Paul J Hauptman
- Department of Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - Zackary D Goff
- Department of Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - Andrija Vidic
- Department of Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - John T Chibnall
- Department of Psychiatry, Saint Louis University School of Medicine, St Louis, Missouri
| | - Barry E Bleske
- College of Pharmacy, University of New Mexico, Albuquerque
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Affiliation(s)
- Michael T Railey
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - Kenyon M Railey
- Department of Family and Community Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Paul J Hauptman
- Department of Medicine (Cardiology), Saint Louis University School of Medicine, St Louis, Missouri
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Affiliation(s)
- Paul J Hauptman
- Division of Cardiology, Department of Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
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