Little is known regarding the health-related quality of life among myocardial infarction (MI) survivors in the United States. The purpose of this population-based study was to identify differences in health-related quality of life domains between MI survivors and propensity score matched controls. This retrospective, cross-sectional matched case-control study examined differences in health-related quality of life (HRQoL) among MI survivors of myocardial infarction compared to propensity score matched controls using data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey. Propensity scores were generated via logistic regression for MI survivors and controls based on gender, race/ethnicity, age, body mass index (BMI), smoking status, and comorbidities. Chi-square tests were used to compare differences between MI survivors to controls for demographic variables. A multivariate analysis of HRQoL domains estimated odds ratios. Life satisfaction, sleep quality, and activity limitations were estimated using binary logistic regression. Social support, perceived general health, perceived physical health, and perceived mental health were estimated using multinomial logistic regression. Significance was set at p < 0.05. The final sample consisted of 16,729 MI survivors matched to 50,187 controls (n = 66,916). Survivors were approximately 2.7 times more likely to report fair/poor general health compared to control (AOR = 2.72, 95% CI: 2.43–3.05) and 1.5 times more likely to report limitations to daily activities (AOR = 1.46, 95% CI: 1.34–1.59). Survivors were more likely to report poor physical health >15 days in the month (AOR = 1.63, 95% CI: 1.46–1.83) and poor mental health >15 days in the month (AOR = 1.25, 95% CI: 1.07–1.46) compared to matched controls. There was no difference in survivors compared to controls in level of emotional support (rarely/never: AOR = 0.75, 95% CI: 0.48–1.18; sometimes: AOR = 0.73, 95% CI: 0.41–1.28), hours of recommended sleep (AOR = 1.14, 95% CI: 0.94–1.38), or life satisfaction (AOR = 1.62, 95% CI: 0.99–2.63). MI survivors experienced lower HRQoL on domains of general health, physical health, daily activity, and mental health compared to the general population.

Increasing gabapentinoid use has raised concerns of misuse and abuse in the United States (US). Little is known about the characteristics of gabapentinoid use in general clinical practice over time. This cross-sectional study used data from the National Ambulatory Medical Care Survey. We examined the trends of patient and prescriber characteristics and the diagnoses associated with US ambulatory care visits involving gabapentinoids for adult visits from 2003 to 2016. Using multivariable logistic regression, we estimated the adjusted proportion of gabapentinoid-involved visits among all visits and tested for trend significance. Among the weighted estimate of 260.1 million gabapentinoid-involved visits (aged 18–64 years: 61.8%; female: 61.9%; white: 85.5%), the adjusted annual proportion of gabapentinoid-involved visits nearly quadrupled from 2003 to 2016 (9.1 to 34.9 per 1000 visits; P_trend < 0.0001), driven mainly by gabapentin. Nearly half had concurrent use with opioids (32.9%) or benzodiazepines (15.3%). Primary care physicians (45.8%), neurologists (8.2%), surgeons (6.2%), and psychiatrists (4.8%) prescribed two-thirds of the gabapentinoids. Most (96.6%) of the gabapentinoid visits did not have an approved indication for gabapentinoids among the first three diagnoses. Among US ambulatory care visits from 2003 to 2016, gabapentinoid use increased substantially, commonly prescribed by primary care physicians.

Introduction: Identifying Alzheimer's disease (AD) pharmacologic treatment options that effectively reduce the risk of mortality and hospitalization in real‐world settings is critical. Methods: We compared donepezil, galantamine, memantine, oral rivastigmine, and transdermal rivastigmine with regard to all‐cause mortality and all‐cause hospitalization risk among fee‐for‐service Medicare beneficiaries with AD (aged ≥ 65 years) using a retrospective cohort study design. Our primary analysis was based on intention to treat (ITT), but we also present as‐treated analysis. Results: In our final study sample (N = 21,558), significant difference in survival among index AD medication groups were observed with donepezil being associated with better survival than memantine, and oral and transdermal forms of rivastigmine for both ITT and as‐treated analysis. Difference in hazards of all‐cause hospitalization among index AD medication groups was observed in ITT analysis but not in as‐treated analysis. Discussion: Significant differences exist in terms of mortality and hospitalization risk with different AD medication initiation in real‐world setting.

Objective. To assess the validity of an exposure score obtained from the Xm²tool for all pharmacological and nonpharmacological strategies used by individuals to manage chronic pain.Methods. Using data from individuals with chronic pain, eXposuremultimodal (Xm²) scores were calculated by assigning one point for every 100 mg of morphine equivalent used (opioid medications); 25% of the maximum recommended exposure used (nonopioid medications); and any use of another strategy then summed. Content, criterion, construct, and convergent validity were assessed.Results. The sample of 149 individuals used a mean of 12.6 (SD = 4.6) strategies to manage pain and had a mean Xm²score of 16.8 (SD = 9.1). Content validity was established by demonstrating that the pain management strategies identified were also reported in the literature. Criterion validity was established by the positive association of exposure scores with the following: interference with work (odds ratio (OR) = 2.23, 95% confidence interval (CI) = 1.14–4.36), daily activities (OR = 2.10, CI = 1.07–4.13), relationships (OR = 1.98, CI = 1.01–3.88), and leisure activities (OR = 2.31, CI = 1.18–4.50); workdays missed (OR = 5.10, CI = 1.92–13.58); emergency department visits (OR = 3.40, CI = 1.17–9.91); hospitalizations (OR = 4.18, CI = 0.86–20.37); and by a negative association with satisfaction (OR = 0.40, CI = 0.18–0.88). Construct validity was established by the positive association of exposure with baseline pain intensity (p<0.01) and odds of experiencing an adverse event (OR = 2.31, CI = 1.18–4.52). Convergent validity was established through correlations of pain intensity from the Xm²score and existing quantitative analgesic questionnaire (QAQ) score.Discussion. Xm²scores represent a valid estimate of total exposure to multimodal strategies used and provide clinically relevant information for deciding what strategies to use at what level.

Percutaneous coronary intervention (PCI) is the preferred treatment for acute coronary syndrome (ACS) secondary to atherosclerotic coronary artery disease. This nonsurgical procedure is also used for selective patients with stable angina. Although the procedure is essential for restoring blood flow, reperfusion can increase oxidative stress as a side effect. We address whether intravenous infusion of vitamin C (VC) prior to PCI provides a benefit for cardioprotection. A total of eight randomized controlled trials (RCT) reported in the literature were selected from 371 publications through systematic literature searches in six electronic databases. The data of VC effect on cardiac injury biomarkers and cardiac function were extracted from these trials adding up to a total of 1185 patients. VC administration reduced cardiac injury as measured by troponin and CK-MB elevations, along with increased antioxidant reservoir, reduced reactive oxygen species (ROS) and decreased inflammatory markers. Improvement of the left ventricular ejection fraction (LVEF) and telediastolic left ventricular volume (TLVV) showed a trend but inconclusive association with VC. Intravenous infusion of VC before PCI may serve as an effective method for cardioprotection against reperfusion injury.