Department of Medicine, UCLA (University of California, Los Angeles) Medical Center, Los Angeles, CA 90095-1679, USA. gfonarow@mednet.ucla.edu; Collective Name: OPTIMIZE-HF Investigators and Hospitals.

BACKGROUND: Few studies have examined factors identified as contributing to heart failure (HF) hospitalization, and, to our knowledge, none has explored their relationship to length of stay and mortality. This study evaluated the association between precipitating factors identified at the time of HF hospital admission and subsequent clinical outcomes. METHODS: During 2003 to 2004, 259 US hospitals in OPTIMIZE-HF submitted data on 48 612 patients, with a prespecified subgroup of at least 10% providing 60- to 90-day follow-up data. Identifiable factors contributing to HF hospitalization were captured at admission and included ischemia, arrhythmia, nonadherence to diet or medications, pneumonia/respiratory process, hypertension, and worsening renal function. Multivariate analyses were performed for length of stay, in-hospital mortality, 60- to 90-day follow-up mortality, and death/rehospitalization. RESULTS: Mean patient age was 73.1 years, 52% of patients were female, and mean ejection fraction was 39.0%. Of 48 612 patients, 29 814 (61.3%) had 1 or more precipitating factors identified, with pneumonia/respiratory process (15.3%), ischemia (14.7%), and arrhythmia (13.5%) bein ... [Continua]

BACKGROUND AND OBJECTIVES: The direct health care costs associated with treating hypertension and dyslipidemia continue to grow in most western countries, including Canada. Despite the proven effectiveness of hypertension and lipid therapies to prevent cardiovascular disease, the cost-effectiveness of long-term primary prevention, as currently advocated by Canadian treatment guidelines, remains to be determined. METHODS: Therapeutic efficiency, defined as person-years of treatment per year of life saved (YOLS) and the cost-effectiveness of treatment were estimated for groups of Canadian adults, 40 to 74 years of age. The clinical indications for treatment were based on the Canadian national guidelines in 2005. Analyses focused on those without cardiovascular disease or diabetes using risk factor data from the Canadian heart health surveys and drug data from a national study, the MyHealthCheckUp survey. The expected impact of therapy was based on published results: statins would result in a 40% drop in low-density lipoprotein cholesterol and a 6% increase in high-density lipoprotein cholesterol, while hypertension therapy would result in a 6.4% drop in systolic and a 5.6% drop in diastolic blood pressure. RESULTS: The estimated daily cost of statins was $1.98 versus $1.72 for a ... [Continua]

 

Hypertension in older adults is not well controlled in clinical practice. Isolated systolic hypertension is often more difficult to manage. A systematic PubMed search was conducted to look for evidence showing benefits of lowering blood pressure (BP) in older hypertensive adults. Lowering BP in these individuals significantly reduces the risk of coronary artery disease, stroke, and cardiovascular and all-cause mortality. Based on trial evidence, a low-dose diuretic should be considered the most appropriate first-step treatment for preventing cardiovascular morbidity and mortality. Therapy with >1 medication is often necessary to reduce BP in these patients. There is unequivocal evidence that cardiovascular events can be prevented in older adults, even those older than 80 years, by treating hypertension.