Arch Intern Med
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Randomized Controlled Trial
Long-term survival in elderly patients hospitalized for heart failure: 14-year follow-up from a prospective randomized trial.
The growing heart failure epidemic imposes a substantial burden on the US health care system. The ability to accurately assess prognosis would allow clinicians to triage patients to appropriate therapy and to plan the intensity of care following hospital discharge. ⋯ Among elderly patients hospitalized with heart failure, median survival is about 2.5 years. However, there is considerable heterogeneity in survival, with 25% of patients dying within 1 year and 25% surviving for more than 5 years. A simple 7-item risk score, based on data readily available at the time of admission, provides a reliable estimate of prognosis.
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Meta Analysis
A meta-analysis of controlled clinical studies with diacerein in the treatment of osteoarthritis.
This systematic meta-analysis on randomized controlled trials with diacerein was performed to provide an evidence-based assessment of its symptomatic efficacy in the treatment of osteoarthritis. ⋯ This systematic meta-analysis provides evidence for the symptomatic efficacy of diacerein in the treatment of knee and hip osteoarthritis, with reasonable tolerability.
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Prior to implementation of the Medicare drug benefit, we estimated the prevalence of cost-related medication nonadherence (CRN) among Medicare enrollees, including elderly and nonelderly disabled beneficiaries. ⋯ One year before Medicare Part D implementation, Medicare beneficiaries reported high rates of CRN. Rates are highest among nonelderly disabled beneficiaries, but among both elderly and disabled beneficiaries, CRN is exacerbated by poor health, multiple morbidities, and limited drug coverage. Given the high cost sharing under Part D, it is important to closely monitor CRN in high-risk subgroups.
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Randomized Controlled Trial
A double-blind, placebo-controlled, crossover study of sildenafil in obstructive sleep apnea.
Sildenafil prolongs the action of cyclic guanosine monophosphate and nitric oxide by inhibiting cyclic guanosine monophosphate-specific phosphodiesterase 5. It is largely used for erectile dysfunction, a highly prevalent condition in obstructive sleep apnea. Because nitric oxide promotes upper airway congestion, muscle relaxation, and pulmonary vasodilation, the aim of this study was to establish the impact of a single 50-mg dose of sildenafil on the sleep of patients with severe obstructive sleep apnea. ⋯ In patients with severe obstructive sleep apnea, a single 50-mg dose of sildenafil at bedtime worsens respiratory and desaturation events.