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  1. Article: COVID-19: responsibility and accountability in a world of rationing

    Jerry II, Robert H

    Journal of Law and the Biosciences

    Abstract: The COVID-19 pandemic is the first modern public health crisis with the potential to overwhelm the public health care system When rationing of services, drugs, and equipment must occur, health care providers have a responsibility to make rationing ... ...

    Abstract The COVID-19 pandemic is the first modern public health crisis with the potential to overwhelm the public health care system When rationing of services, drugs, and equipment must occur, health care providers have a responsibility to make rationing decisions fairly, both procedurally and substantively In addition, health care providers, like all professionals, are accountable for their decisions The legal standard of care requires providers to exercise the skill and knowledge normally possessed by providers in good standing in the same field or class of practice acting in the same or similar circumstances But making rationing decisions in crisis conditions, like those created by COVID-19, is not the same as or similar to decision making in non-crisis conditions Thus, the standard of care, properly applied, expects less of providers practicing under the stress of COVID-19’s triage conditions Because many health care providers do not perceive this is true, and for pragmatic and normative reasons, policymakers should articulate rules limiting providers’ liability for rationing decisions—as well as other acts and omissions—occurring in and attendant to crisis conditions These rules should not, however, create absolute immunities As the COVID-19 pandemic unfolds, more states are embracing this approach
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #756923
    Database COVID19

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  2. Article ; Online: COVID-19

    Jerry II, Robert H

    Journal of Law and the Biosciences ; ISSN 2053-9711

    responsibility and accountability in a world of rationing

    2020  

    Abstract: Abstract The COVID-19 pandemic is the first modern public health crisis with the potential to overwhelm the public health care system. When rationing of services, drugs, and equipment must occur, health care providers have a responsibility to make ... ...

    Abstract Abstract The COVID-19 pandemic is the first modern public health crisis with the potential to overwhelm the public health care system. When rationing of services, drugs, and equipment must occur, health care providers have a responsibility to make rationing decisions fairly, both procedurally and substantively. In addition, health care providers, like all professionals, are accountable for their decisions. The legal standard of care requires providers to exercise the skill and knowledge normally possessed by providers in good standing in the same field or class of practice acting in the same or similar circumstances. But making rationing decisions in crisis conditions, like those created by COVID-19, is not the same as or similar to decision making in non-crisis conditions. Thus, the standard of care, properly applied, expects less of providers practicing under the stress of COVID-19’s triage conditions. Because many health care providers do not perceive this is true, and for pragmatic and normative reasons, policymakers should articulate rules limiting providers’ liability for rationing decisions—as well as other acts and omissions—occurring in and attendant to crisis conditions. These rules should not, however, create absolute immunities. As the COVID-19 pandemic unfolds, more states are embracing this approach.
    Keywords covid19
    Language English
    Publisher Oxford University Press (OUP)
    Publishing country uk
    Document type Article ; Online
    DOI 10.1093/jlb/lsaa076
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Adverse Events After Initiating Angiotensin-Converting Enzyme Inhibitor/Angiotensin II Receptor Blocker Therapy in Individuals with Heart Failure and Multimorbidity.

    Tisminetzky, Mayra / Gurwitz, Jerry H / Tabada, Grace / Reynolds, Kristi / Fortmann, Stephen P / Garcia, Elisha / Pham, Thu / Goldberg, Robert / Go, Alan S

    The American journal of medicine

    2022  Volume 135, Issue 12, Page(s) 1468–1477

    Abstract: ... II receptor blocker (ARB) therapy. However, evidence is lacking on whether routine follow-up testing ...

    Abstract Background: Current clinical practice guidelines recommend routine kidney function and serum potassium testing within 30 days of initiating angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) therapy. However, evidence is lacking on whether routine follow-up testing reduces therapy-related adverse events in adults with heart failure and if multimorbidity influences the association between laboratory testing and these adverse events.
    Methods: We conducted a retrospective cohort study among adults with heart failure from 4 US integrated health care delivery systems. Multimorbidity was defined using counts of chronic conditions. Patients with outpatient serum creatinine and potassium tests in the 30 days after starting ACEI or ARB therapy were matched 1:1 to patients without follow-up tests. We evaluated the association of follow-up testing with 30-day all-cause mortality and hospitalization with acute kidney injury or hyperkalemia using Cox regression.
    Results: We identified 3629 matched adults with heart failure initiating ACEI or ARB therapy between January 1, 2005, and December 31, 2012. Follow-up testing was not significantly associated with 30-day all-cause mortality (adjusted hazard ratio [aHR] 0.45, 95% confidence interval [CI] 0.14; 1.39) and hospitalization with hyperkalemia (aHR 0.73, 95% CI, 0.33; 1.61). However, follow-up testing was significantly associated with hospitalization with acute kidney injury (aHR, 1.40, 95% CI, 1.01; 1.94). Interaction between multimorbidity burden and follow-up testing was not statistically significant in any of the outcome models examined.
    Conclusions: Routine laboratory monitoring after ACEI or ARB therapy initiation was not associated with risk of 30-day all-cause mortality or hospitalization with hyperkalemia across the spectrum of multimorbidity burden in a cohort of patients with heart failure.
    MeSH term(s) Humans ; Adult ; Multimorbidity ; Hyperkalemia/chemically induced ; Hyperkalemia/epidemiology ; Angiotensin-Converting Enzyme Inhibitors/adverse effects ; Angiotensin Receptor Antagonists/adverse effects ; Retrospective Studies ; Heart Failure/drug therapy ; Heart Failure/epidemiology ; Acute Kidney Injury ; Potassium ; Antiviral Agents
    Chemical Substances Angiotensin-Converting Enzyme Inhibitors ; Angiotensin Receptor Antagonists ; Potassium (RWP5GA015D) ; Antiviral Agents
    Language English
    Publishing date 2022-09-02
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 80015-6
    ISSN 1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
    ISSN (online) 1555-7162 ; 1873-2178
    ISSN 0002-9343 ; 1548-2766
    DOI 10.1016/j.amjmed.2022.08.010
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Tissue plasminogen activator in left ventricular assist device-related intravascular hemolysis after failed augmented anticoagulation.

    Kenneth Sims, Robert / Srour, Nina / El Nihum, Lamees I / Hannawi, Bashar / Araujo-Gutierrez, Raquel / Cruz-Solbes, Ana S / Trachtenberg, Barry H / Hussain, Imad / Kim, Ju H / Kassi, Mahwash / Graviss, Edward A / Nguyen, Duc T / Estep, Jerry / Bhimaraj, Arvind / Guha, Ashrith

    The International journal of artificial organs

    2022  Volume 45, Issue 11, Page(s) 911–918

    Abstract: ... IVH) in patients with the HeartMate II (HM-II) continuous flow (CF) left ventricular assist device ... in some patients.: Methods: We performed a retrospective study of 31 HM-II CF LVAD patients admitted ...

    Abstract Objectives: We sought to examine the efficacy and safety of adding fibrinogen-guided low-dose multi-day Alteplase™ tissue plasminogen activator (tPA) in the management of intravascular hemolysis (IVH) in patients with the HeartMate II (HM-II) continuous flow (CF) left ventricular assist device (LVAD) who failed to achieve IVH resolution with conventional augmented anticoagulation (AAC).
    Background: IVH in patients with LVAD is often treated with AAC, failing which pump exchange is considered. We hypothesized that a trial of low-dose tPA after failed AAC therapy could resolve IVH and prevent pump exchange in some patients.
    Methods: We performed a retrospective study of 31 HM-II CF LVAD patients admitted to our center from January 2015 to January 2020 for IVH management who received tPA following failed AAC. Primary 6-month outcomes included successful IVH resolution, unsuccessful IVH resolution requiring pump exchange, gastrointestinal bleeding, ischemic and hemorrhagic cerebrovascular accident (CVA), and death.
    Results: Thirty-one patients with IVH were treated with tPA following failed AAC. Successful resolution of IVH occurred in 22/31 (71%) patients. Pump exchange occurred in 9/31 (29%) patients. Gastrointestinal bleeding occurred in 7/31 (22.6%) patients. Ischemic CVA occurred in 6/31 (19.4%) patients.
    Conclusions: Management of IVH with administration of low-dose tPA after failed AAC is feasible and may prevent pump exchange in some patients.
    MeSH term(s) Anticoagulants/adverse effects ; Fibrinogen/therapeutic use ; Gastrointestinal Hemorrhage/etiology ; Heart Failure/therapy ; Heart-Assist Devices/adverse effects ; Hemolysis ; Humans ; Retrospective Studies ; Thrombosis/prevention & control ; Tissue Plasminogen Activator/adverse effects
    Chemical Substances Anticoagulants ; Fibrinogen (9001-32-5) ; Tissue Plasminogen Activator (EC 3.4.21.68)
    Language English
    Publishing date 2022-08-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80456-3
    ISSN 1724-6040 ; 0391-3988
    ISSN (online) 1724-6040
    ISSN 0391-3988
    DOI 10.1177/03913988221115445
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Pillars Article: Three-Dimensional Structure of a Human Class II Histocompatibility Molecule Complexed with Superantigen.

    Jardetzky, Theodore S / Brown, Jerry H / Gorga, Joan C / Stern, Lawrence J / Urban, Robert G / Chi, Young-In / Stauffacher, Cynthia / Strominger, Jack L / Wiley, Don C

    Journal of immunology (Baltimore, Md. : 1950)

    2018  Volume 201, Issue 7, Page(s) 1819–1826

    Language English
    Publishing date 2018-09-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3056-9
    ISSN 1550-6606 ; 0022-1767 ; 1048-3233 ; 1047-7381
    ISSN (online) 1550-6606
    ISSN 0022-1767 ; 1048-3233 ; 1047-7381
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Pillars article: three-dimensional structure of the human class II histocompatibility antigen HLA-DR1. Nature. 1993. 364: 33-39.

    Brown, Jerry H / Jardetzky, Theodore S / Gorga, Joan C / Stern, Lawrence J / Urban, Robert G / Strominger, Jack L / Wiley, Don C

    Journal of immunology (Baltimore, Md. : 1950)

    2015  Volume 194, Issue 1, Page(s) 5–11

    MeSH term(s) HLA-DR1 Antigen/chemistry ; Humans
    Chemical Substances HLA-DR1 Antigen
    Language English
    Publishing date 2015-01-01
    Publishing country United States
    Document type Comment ; Journal Article
    ZDB-ID 3056-9
    ISSN 1550-6606 ; 0022-1767 ; 1048-3233 ; 1047-7381
    ISSN (online) 1550-6606
    ISSN 0022-1767 ; 1048-3233 ; 1047-7381
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Longitudinal Follow-Up of Participants With Tobacco Exposure and Preserved Spirometry.

    McKleroy, William / Shing, Tracie / Anderson, Wayne H / Arjomandi, Mehrdad / Awan, Hira Anees / Barjaktarevic, Igor / Barr, R Graham / Bleecker, Eugene R / Boscardin, John / Bowler, Russell P / Buhr, Russell G / Criner, Gerard J / Comellas, Alejandro P / Curtis, Jeffrey L / Dransfield, Mark / Doerschuk, Claire M / Dolezal, Brett A / Drummond, M Bradley / Han, MeiLan K /
    Hansel, Nadia N / Helton, Kinsey / Hoffman, Eric A / Kaner, Robert J / Kanner, Richard E / Krishnan, Jerry A / Lazarus, Stephen C / Martinez, Fernando J / Ohar, Jill / Ortega, Victor E / Paine, Robert / Peters, Stephen P / Reinhardt, Joseph M / Rennard, Stephen / Smith, Benjamin M / Tashkin, Donald P / Couper, David / Cooper, Christopher B / Woodruff, Prescott G

    JAMA

    2023  Volume 330, Issue 5, Page(s) 442–453

    Abstract: ... participants: SPIROMICS II was an extension of SPIROMICS I, a multicenter study of persons aged 40 to 80 years ... Participants were enrolled in SPIROMICS I and II from November 10, 2010, through July 31, 2015, and followed up ... to 4 years. Participants in SPIROMICS II had 1 additional in-person visit 5 to 7 years after enrollment ...

    Abstract Importance: People who smoked cigarettes may experience respiratory symptoms without spirometric airflow obstruction. These individuals are typically excluded from chronic obstructive pulmonary disease (COPD) trials and lack evidence-based therapies.
    Objective: To define the natural history of persons with tobacco exposure and preserved spirometry (TEPS) and symptoms (symptomatic TEPS).
    Design, setting, and participants: SPIROMICS II was an extension of SPIROMICS I, a multicenter study of persons aged 40 to 80 years who smoked cigarettes (>20 pack-years) with or without COPD and controls without tobacco exposure or airflow obstruction. Participants were enrolled in SPIROMICS I and II from November 10, 2010, through July 31, 2015, and followed up through July 31, 2021.
    Exposures: Participants in SPIROMICS I underwent spirometry, 6-minute walk distance testing, assessment of respiratory symptoms, and computed tomography of the chest at yearly visits for 3 to 4 years. Participants in SPIROMICS II had 1 additional in-person visit 5 to 7 years after enrollment in SPIROMICS I. Respiratory symptoms were assessed with the COPD Assessment Test (range, 0 to 40; higher scores indicate more severe symptoms). Participants with symptomatic TEPS had normal spirometry (postbronchodilator ratio of forced expiratory volume in the first second [FEV1] to forced vital capacity >0.70) and COPD Assessment Test scores of 10 or greater. Participants with asymptomatic TEPS had normal spirometry and COPD Assessment Test scores of less than 10. Patient-reported respiratory symptoms and exacerbations were assessed every 4 months via phone calls.
    Main outcomes and measures: The primary outcome was assessment for accelerated decline in lung function (FEV1) in participants with symptomatic TEPS vs asymptomatic TEPS. Secondary outcomes included development of COPD defined by spirometry, respiratory symptoms, rates of respiratory exacerbations, and progression of computed tomographic-defined airway wall thickening or emphysema.
    Results: Of 1397 study participants, 226 had symptomatic TEPS (mean age, 60.1 [SD, 9.8] years; 134 were women [59%]) and 269 had asymptomatic TEPS (mean age, 63.1 [SD, 9.1] years; 134 were women [50%]). At a median follow-up of 5.76 years, the decline in FEV1 was -31.3 mL/y for participants with symptomatic TEPS vs -38.8 mL/y for those with asymptomatic TEPS (between-group difference, -7.5 mL/y [95% CI, -16.6 to 1.6 mL/y]). The cumulative incidence of COPD was 33.0% among participants with symptomatic TEPS vs 31.6% among those with asymptomatic TEPS (hazard ratio, 1.05 [95% CI, 0.76 to 1.46]). Participants with symptomatic TEPS had significantly more respiratory exacerbations than those with asymptomatic TEPS (0.23 vs 0.08 exacerbations per person-year, respectively; rate ratio, 2.38 [95% CI, 1.71 to 3.31], P < .001).
    Conclusions and relevance: Participants with symptomatic TEPS did not have accelerated rates of decline in FEV1 or increased incidence of COPD vs those with asymptomatic TEPS, but participants with symptomatic TEPS did experience significantly more respiratory exacerbations over a median follow-up of 5.8 years.
    MeSH term(s) Female ; Humans ; Male ; Middle Aged ; Disease Progression ; Follow-Up Studies ; Forced Expiratory Volume ; Lung/diagnostic imaging ; Lung/physiopathology ; Pulmonary Disease, Chronic Obstructive/diagnostic imaging ; Pulmonary Disease, Chronic Obstructive/etiology ; Pulmonary Disease, Chronic Obstructive/physiopathology ; Spirometry ; Vital Capacity ; Longitudinal Studies ; Cigarette Smoking/adverse effects ; Cigarette Smoking/physiopathology ; Lung Diseases/diagnostic imaging ; Lung Diseases/etiology ; Lung Diseases/physiopathology ; Respiratory Function Tests
    Language English
    Publishing date 2023-07-31
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2023.11676
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: Updated guidance on the management of COVID-19: from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020)

    Bai, Chunxue / Chotirmall, Sanjay H / Rello, Jordi / Alba, George A / Ginns, Leo C / Krishnan, Jerry A / Rogers, Robert / Bendstrup, Elisabeth / Burgel, Pierre-Regis / Chalmers, James D / Chua, Abigail / Crothers, Kristina A / Duggal, Abhijit / Kim, Yeon Wook / Laffey, John G / Luna, Carlos M / Niederman, Michael S / Raghu, Ganesh / Ramirez, Julio A /
    Riera, Jordi / Roca, Oriol / Tamae-Kakazu, Maximiliano / Torres, Antoni / Watkins, Richard R / Barrecheguren, Miriam / Belliato, Mirko / Chami, Hassan A / Chen, Rongchang / Cortes-Puentes, Gustavo A / Delacruz, Charles / Hayes, Margaret M / Heunks, Leo M A / Holets, Steven R / Hough, Catherine L / Jagpal, Sugeet / Jeon, Kyeongman / Johkoh, Takeshi / Lee, May M / Liebler, Janice / McElvaney, Gerry N / Moskowitz, Ari / Oeckler, Richard A / Ojanguren, Iñigo / O039, / Regan, Anthony / Pletz, Mathias W / Rhee, Chin Kook / Schultz, Marcus J / Storti, Enrico / Strange, Charlie / Thomson, Carey C

    Abstract: BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research. METHODS: An International ... ...

    Abstract BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research. METHODS: An International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion. RESULTS: The Task Force made consensus suggestions to treat patients with acute COVID-19 pneumonia with remdesivir and dexamethasone but suggested against hydroxychloroquine except in the context of a clinical trial; these are revisions of prior suggestions resulting from the interim publication of several randomised trials. It also suggested that COVID-19 patients with a venous thromboembolic event be treated with therapeutic anticoagulant therapy for 3†months. The Task Force was unable to reach sufficient agreement to yield consensus suggestions for the post-hospital care of COVID-19 survivors. The Task Force fell one vote shy of suggesting routine screening for depression, anxiety and post-traumatic stress disorder. CONCLUSIONS: The Task Force addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #835811
    Database COVID19

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  9. Article ; Online: Proteasome inhibition and mechanism of resistance to a synthetic, library-based hexapeptide.

    Oerlemans, Ruud / Berkers, Celia R / Assaraf, Yehuda G / Scheffer, George L / Peters, Godefridus J / Verbrugge, Sue Ellen / Cloos, Jacqueline / Slootstra, Jerry / Meloen, Rob H / Shoemaker, Robert H / Dijkmans, Ben A C / Scheper, Rik J / Ovaa, Huib / Jansen, Gerrit

    Investigational new drugs

    2018  Volume 36, Issue 5, Page(s) 797–809

    Abstract: ... with their cell growth inhibition potencies; (ii) 4A6 reversibly inhibited functional β5 active site ...

    Abstract Background The hexapeptide 4A6 (Ac-Thr(tBu)-His(Bzl)-Thr(Bzl)-Nle-Glu(OtBu)-Gly-Bza) was isolated from a peptide library constructed to identify peptide-based transport inhibitors of multidrug resistance (MDR) efflux pumps including P-glycoprotein and Multidrug Resistance-associated Protein 1. 4A6 proved to be a substrate but not an inhibitor of these MDR efflux transporters. In fact, 4A6 and related peptides displayed potent cytotoxic activity via an unknown mechanism. Objective To decipher the mode of cytotoxic activity of 4A6. Methods Screening of 4A6 activity was performed against the NCI60 panel of cancer cell lines. Possible interactions of 4A6 with the 26S proteasome were assessed via proteasome activity and affinity labeling, and cell growth inhibition studies with leukemic cells resistant to the proteasome inhibitor bortezomib (BTZ). Results The NCI60 panel COMPARE analysis revealed that 4A6 had an activity profile overlapping with BTZ. Consistently, 4A6 proved to be a selective and reversible inhibitor of β5 subunit (PSMB5)-associated chymotrypsin-like activity of the 26S proteasome. This conclusion is supported by several lines of evidence: (i) inhibition of chymotrypsin-like proteasome activity by 4A6 and related peptides correlated with their cell growth inhibition potencies; (ii) 4A6 reversibly inhibited functional β5 active site labeling with the affinity probe BodipyFL-Ahx
    MeSH term(s) Animals ; Antineoplastic Agents/pharmacology ; Apoptosis/drug effects ; Bortezomib/pharmacology ; Cell Line ; Drug Resistance, Neoplasm ; Humans ; Mice ; Oligopeptides/pharmacology ; Peptide Library ; Proteasome Inhibitors/pharmacology
    Chemical Substances Antineoplastic Agents ; Oligopeptides ; Peptide Library ; Proteasome Inhibitors ; Bortezomib (69G8BD63PP)
    Language English
    Publishing date 2018-02-14
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 604895-x
    ISSN 1573-0646 ; 0167-6997
    ISSN (online) 1573-0646
    ISSN 0167-6997
    DOI 10.1007/s10637-018-0569-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Treatment Effectiveness in Heart Failure with Comorbidity: Lung Disease and Kidney Disease.

    Gurwitz, Jerry H / Magid, David J / Smith, David H / Tabada, Grace H / Sung, Sue Hee / Allen, Larry A / McManus, David D / Goldberg, Robert J / Tisminetzky, Mayra / Go, Alan S

    Journal of the American Geriatrics Society

    2017  Volume 65, Issue 12, Page(s) 2610–2618

    Abstract: ... angiotensin II receptor blockers (ARBs) in individuals with HF and chronic kidney disease.: Design ...

    Abstract Objectives: To assess the clinical effectiveness of beta-blocker therapy in individuals with heart failure (HF) and chronic lung disease and of angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor blockers (ARBs) in individuals with HF and chronic kidney disease.
    Design: Retrospective cohort study.
    Setting: Community.
    Participants: Individuals with HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF).
    Methods: We undertook separate new-user cohort studies to assess the effectiveness of beta-blocker therapy in treating HF and chronic lung disease and ACE-Is and ARBs in treating HF and chronic kidney disease (CKD). Individuals with a chronic lung disease diagnosis were included in the group with HF and chronic lung disease (International Classification of Diseases, Ninth Revision, codes 490-496, 518). Individuals with an estimated glomerular filtration rate less than 60 mL/min per 1.73 m
    Results: For individuals with HFrEF with chronic lung disease, beta-blocker therapy was protective against death (relative risk (RR) = 0.58, 95% confidence interval (CI) = 0.44-0.77) and hospitalization for HF (RR = 0.78, 95% CI = 0.60-1.00). For those with HFpEF, no statistically significant associations between beta-blocker therapy use and any of the outcomes were observed. We found ACE-I and ARB use to be protective against all three outcomes of interest in individuals with HFrEF (death from any cause: RR = 0.60, 95% 0.40-0.91; hospitalization for HF: RR = 0.43, 95% CI = 0.28-0.67; hospitalization for any reason: RR = 0.63, 95% CI = 0.45-0.89, respectively) and those with HFpEF (death from any cause: RR = 0.52, 95% CI = 0.33-0.81; hospitalization for HF: RR = 0.35, 95% CI = 0.18-0.68; hospitalization for any reason: RR = 0.67, 95% CI = 0.47-0.95).
    Conclusion: Large observational studies may allow for identification of important subgroups of individuals with HF that might benefit from existing treatment approaches. Our findings may also better inform the design of more-definitive future observational studies and randomized trials.
    MeSH term(s) Adrenergic beta-Antagonists/therapeutic use ; Adult ; Aged ; Aged, 80 and over ; Angiotensin Receptor Antagonists/therapeutic use ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Chronic Disease ; Cohort Studies ; Female ; Heart Failure/complications ; Heart Failure/drug therapy ; Hospitalization ; Humans ; Lung Diseases/complications ; Male ; Middle Aged ; Renal Insufficiency, Chronic/complications ; Retrospective Studies ; Treatment Outcome
    Chemical Substances Adrenergic beta-Antagonists ; Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors
    Language English
    Publishing date 2017-09-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80363-7
    ISSN 1532-5415 ; 0002-8614
    ISSN (online) 1532-5415
    ISSN 0002-8614
    DOI 10.1111/jgs.15062
    Database MEDical Literature Analysis and Retrieval System OnLINE

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