Does multimorbidity still remain a matter of the elderly: Lithuanian national data analysis.

INTRODUCTION: Multimorbidity - the coexistence of ≥2 chronic conditions in same individual is usually associated with older age. There is an increase in its prevalence at a much younger age, however with very limited research specifying that. OBJECTIVE: To identify age breaking points for the occurrence of multimorbidity. METHODS: The study included patients, who used any healthcare services between the 01/01/2012 and 30/06/2014. Patients were divided into two groups - with single chronic condition and with multimorbidity. Age-specific proportion of multimorbidity, rate of primary and outpatient visits, number of hospitalizations and prescribed reimbursed medications between these groups were analyzed. RESULTS: The study included 452578 patients, 94.63% of them had more than one chronic condition. The risk increase with every consecutive year for developing multimorbidity was between the age of 28 and 39 years. The age breaking point for the rapid increase in hospitalizations was about 29 years in multimorbidity group. The proportion of patients with multimorbidity using expensive medications starts to increase at the age of 41. CONCLUSIONS: The risk of acquiring an additional chronic condition rises exponentially from the age of 29 years and platos between the age of 51 and 57. Patients with multimorbidity require increasing amounts of primary healthcare resources, where patients with single chronic condition require decreasing primary care usage, possibly attributed to successful patient empowerment.

Prevalence and structure of multiple chronic conditions in Lithuanian population and the distribution of the associated healthcare resources.

BACKGROUND: Chronic multiple conditions have become a major threat to the world's healthcare systems within the last years. OBJECTIVE: To estimate the prevalence and structure of chronic conditions in Lithuania and to analyse the utilisation of healthcare resources striving to manage patients with multimorbidity. METHODS: It was based on the National Health Insurance Fund (NHIF) database, that covered the period from January, 2012 to June, 2014 and included 452,769 subjects. The prevalence of multimorbidity in Lithuania, the structure of chronic diseases within the age and gender groups as well as the association between multimorbidity and facilities usage were analysed. RESULTS: The prevalence of chronic diseases in adult Lithuanian population was 17.2%, where 94.6% (N=428 430) of the chronically diseased subjects had >1 chronic condition. The number of chronic conditions increased with the age, especially at the age of 45-54 years, and male gender (p<0.001). 10% of patients had at least 2 chronic diseases at the age of 45 and over. Multimorbidity accounted for 258,761 additional bed days per year nationally and 61% increase in the 30-day readmission rate. Primary care and outpatient visits per 1000 population were 2.1 times more prevalent and home visits were 9.6 times more frequent in multimorbid patients compared to a single chronic disease. CONCLUSIONS: Multimorbidity and its increasing prevalence among the younger patients will put additional strain on healthcare resources at an earlier stage by increasing admission, readmission rates and vastly increasing primary care contacts.

Doppler echocardiography during transesophageal atrial pacing in the detection of coronary artery disease. Stress Doppler echocardiography in the detection of coronary artery disease.

The aim of this study was to assess the applicability of the Doppler echocardiogram (EchoKG) during transesophageal atrial pacing (TAP) with respect to the detection of coronary artery disease (CAD). Aortic flow peak velocity (PV), mean acceleration (MA), stroke distance (SD), minute distance (MD) and time to PV were measured using pulsed Doppler EchoKG during sinus rhythm and at pacing rates of 120 and 140 bpm in 11 patients, taken as subjects, with CAD defined by coronary arteriography and 15 patients without CAD (the control group). Similar changes of PV, SD, MD and time to PV during TAP were observed in subjects with and without CAD. Only changes of MA were different between subjects with and without CAD:MA during TAP remained unchanged in the control group and decreased from 1055.2 +/- 49.7 cm/s2 (baseline) to 829.0 +/- 55.9 cm/s2 at pacing rate 140 bpm (p < 0.05) in subjects with CAD. On the basis of these data we suggest a new criterion for the detection of hemodynamically significant CAD: decrease of MA at a pacing rate of 140 bpm > 15% of initial value. Its specificity and sensitivity in the detection of CAD were respectively 87% and 82%. We conclude that the Doppler EchoKG during TAP is a relatively simple and reliable method for the diagnosis of CAD, and that the response of the Doppler EchoKG parameter of MA to TAP is a sensitive and specific index, useful for the detection of significant coronary artery stenosis.

R wave amplitude changes during transoesophageal atrial pacing in patients with chronic ischaemic heart disease.

15 patients with intact coronary arteries (control group) and 49 patients with coronary stenosis were for the purpose of differential diagnosis of ischaemic heart disease [IHD] subjected to coronarography, left ventriculography and transesophageal atrial pacing. The possibility of using the sum R wave amplitude as a criterion of IHD was assessed, as well as the relation between the R wave amplitude and the left ventricular function indicators--the ejection fraction and the end-diastolic volume. It was found that the increase of the R wave amplitude has distinctly lower specificity (40%) and sensitivity (29%) than the ischaemic depression of the ST segment (73 and 74% respectively). No correlation was found between R wave amplitude changes and indicators of the left ventricular function. The increase in the R wave amplitude cannot be therefore regarded as a reliable criterion of IHD and is not a reflection of the functional state of the left ventricle.