Differentiating Characteristics and Responses to Treatment of New-Onset Heart Failure With Preserved and Reduced Ejection Fraction in Ambulatory Patients.

Background: Differences in clinical presentation and therapy outcomes between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) have been reported but described mainly among hospitalized patients. Because the population of outpatients with heart failure (HF) is increasing, we sought to discriminate the clinical presentation and responses to medical therapy in ambulatory patients with new-onset HFpEF vs. HFrEF. Methods: We retrospectively included all patients with new-onset HF treated at a single HF clinic in the past 4 years. Clinical data and electrocardiography (ECG) and echocardiography findings were recorded. Patients were followed up once weekly, and treatment response was evaluated according to symptoms resolution within 30 days. Univariate and multivariate regression analyses were performed. Results: A total of 146 patients were diagnosed with new-onset HF: 68 with HFpEF and 78 with HFrEF. The patients with HFrEF were older than those with HFpEF (66.9 vs. 62 years, respectively, P = 0.008). Patients with HFrEF were more likely to have coronary artery disease, atrial fibrillation, or valvular heart disease than those with HFpEF (P < 0.05 for all). Patients with HFrEF rather than HFpEF were more likely to present with New York Heart Association class 3 - 4 dyspnea, orthopnea, paroxysmal nocturnal dyspnea or low cardiac output (P < 0.007 for all). Patients with HFpEF were more likely than those with HFpEF to have normal ECG at presentation (P < 0.001), and left bundle branch block (LBBB) was observed only in patients with HFrEF (P < 0.001). Resolution of symptoms within 30 days occurred in 75% of patients with HFpEF and 40% of patients with HFrEF (P < 0.001). Conclusions: Ambulatory patients with new-onset HFrEF were older, and had higher incidence of structural heart disease, in comparison to those with new-onset HFpEF. Patients presenting with HFrEF had more severe functional symptoms than those with HFpEF. Patients with HFpEF were more likely than those with HFpEF to have normal ECG at the time of presentation, and LBBB was strongly associated with HFrEF. Outpatients with HFrEF rather than HFpEF were less likely to respond to treatment.

Comparison of herbal medicines and pain relief medications in the treatment of primary dysmenorrhoea among female medical students at Taibah University.

Objectives: Dysmenorrhoea is a common gynaecological problem that affects many women during their reproductive years. The objectives of this study were to describe the different treatments used for primary dysmenorrhoea (PD) among medical students at Taibah University, and to investigate the link between pain severity and daily life activities in relation to the type of dysmenorrhoea treatment. Methods: A cross-sectional study was conducted on 301 female medical students through an 18-item self-administered electronic questionnaire to screen for students with PD. The questionnaire included sociodemographic characteristics, details of self-management methods (types and adverse events), daily life domains affected by pain, and the Visual Analogue Scale score for the pain (wherein a score ≥7 indicated severe pain). Chi-square test, a multivariate regression model, and correlation analysis were used for data analysis. Results: The prevalence of PD among respondents was 71.8%. Medications were used by more than half of the respondents (51.9%), and were mainly non-steroidal anti-inflammatory drugs (53.5%) and paracetamol (47.5%). Among the participants, 14.1% used herbal medicines, cinnamon (55.7%), chamomile (40.7%), and ginger (33.3%). Other pain relief modalities were used by 34% of participants. Most students with a history of PD (80.6%) reported effects on their daily activities, mainly mood disturbance. Students using medications were more likely to have severe pain (72.7%) and an affect on daily activities (92.9%) than those using herbal medicines (44.4% and 88.9%, respectively) and other treatments (47.7% and 70.8%, respectively) (p < 0.001). Conclusions: Medications were more commonly used than herbal medicines and other relief methods. Effects of PD on daily life activities were observed among most students treated with medications. We recommend health promotion programmes to increase the awareness regarding different pain relief methods.