Global prevalence of chronic obstructive pulmonary disease: systematic review and meta-analysis

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide.

Aims: To synthesize data on the worldwide prevalence and severity of COPD by geographical region, age groups, and smoking status in a systematic review.

Methods: A systematic search was performed following Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. International databases including PubMed, Scopus and Web of Science were searched for population-based studies published between January 2004 and May 2015 that reported the prevalence of COPD anywhere in the world. The prevalence of COPD was calculated based on World Health Organization (WHO) regions and sex and severity stages using metaprop. Meta-regression and subgroup analysis were applied to determine the sources of heterogeneity.

Results: Sixty papers were screened with a combined subject sample size of 127 598. The prevalence of post-bronchodilator COPD was 12.16% (10.91–13.40%). The pooled prevalence of COPD was 15.70% (13.80–18.59%) in men and 9.93% (8.73-11.13%) in women. Among all WHO regions, the highest prevalence was recorded in the Region of the Americas (14.53%), and the lowest was recorded in the South-East Asia Region/Western Pacific Region (8.80%). Meta-regression model variables were: sample size, WHO region, study quality score, level of gathering data, publication year, and sampling methods that justified 29.82% of heterogeneity detected among COPD prevalence rates worldwide.

Conclusions: Global prevalence of COPD among men is about 5% higher than among women. The most prevalent stage of COPD is stage 1

Cardiovascular disease prevention using fixed dose pharmaco-therapy in Iran: updated meta-analyses and mortality estimation

Short term randomized trials have shown the effectiveness of a fixed dose combination therapy [known as Polypill] on reducing blood pressure and serum cholesterol but the impact of Polypill on cardiovascular disease risk or mortality has not yet been directly investigated. Previous studies combined the effects of each component assuming a multiplicative joint risk assumption that may have led to overestimating the combined effects. We conducted an updated meta-analysis of randomized trials of anti-hypertensives, statins and aspirin. We used the estimated effect sizes applying a more conservative assumption to estimate the number of ischemic heart disease [lHD] and stroke deaths that could have been averted by Polypill in Iranians aged 55 years or older in 2006. We searched Medline and reviewed previous meta-analyses to select randomized trials on Angiotensin Converting Enzyme- inhibitors, thiazides, aspirin, and statins. We used a random-effects model to pool relative risks for each component and estimated the joint relative risks using multiplicative and additive assumptions for 4 combinations of Polypill components. We used age- and cause-specific mortality, separately by gender, and estimated the number of preventable deaths from IHD and stroke. Under the additive joint RR assumption, the standard Polypill formulation was estimated to prevent 28500 [95% Cl: 21700, 34100] IHD deaths and 12700 [95% Cl: 8800, 15900] stroke deaths. Removing aspirin from the combination decreased preventable IHD deaths by 15% under the additive assumption [5600 deaths] and by 21% under the multiplicative assumption [6800 deaths] and reduced preventable stroke deaths under both additive and multiplicative assumptions by 3% [300 deaths]. There was no significant difference between Polypill combinations with anti-hypertensive agents in full-dose or half-dose. Polypill can prevent a large number of IHID and stroke deaths in Iran. The cost-effectiveness, feasibility, and acceptability of this prevention strategy remain to be investigated

completeness of medical records to assess quality of hospital care: the case of acute myocardial infarction in a district-level general hospital in Iran

Quantifying the quality of care in high-cost and fatal conditions such as acute myocardial infarction [AMI] is a crucial step toward improving clinical outcomes in these patients. The main objective of this pilot study is to show whether abstraction of medical charts would be a useful method to systematically assess quality of care in patients hospitalized for AMI in a general hospital that has no interventional cardiac technology. A general physician and a cardiologist working with Shahid Gholipour Hospital in Bukan, Northwest Iran, retrospectively abstracted medical records of all patients with verified diagnoses of myocardial infarction who were hospitalized between April 1, 2010 and March 31, 2011. The targeted outcome variables were risk-adjusted mortality and risk-adjusted length of hospital stay. Process quality indicators were selected from those developed by the National Quality Forum [NQF] of the United States. We reported completeness of selected variables used to build and calculate quality indicators in this study. For most variables, missing values were negligible. However, missing data on fields related to contraindications for prescribed medications were common. Medical chart abstractions provide useful first steps in assessing differences in the quality of hospital care for patients with AMI. Extension of our pilot study is highly recommended and may help trigger policy decisions to promote hospital quality in Iran