RESUMO
BACKGROUND: Intra-articular hyaluronic acid (IAHA) products are often used in the treatment of adults with mild-to-moderate knee osteoarthritis (KOA). The International Symposium on Intra-Articular Treatment (ISIAT) convened a multidisciplinary technical expert panel to define characteristics for an innovative IAHA product that should answer unmet needs in the clinical management of adults with mild-to-moderate KOA. METHODS: An initial set of evidence-based statements was developed based on data extracted from articles identified through a comprehensive literature search. A Delphi panel comprising 19 experts in KOA voted in 3 rounds to rate their degree of agreement with accepted statements. RESULTS: The final set of 13 accepted statements focus on the effect of an innovative IAHA across 5 key domains of nociceptive pain, joint function, quality of life, joint structure and integrity, and adverse effects. The statements set thresholds for clinically meaningful improvements that exceed those generally achievable by currently available IAHA products. CONCLUSION: The characteristics described by these statements from the ISIAT set new standards for what should be expected from an innovative IAHA. These statements should serve as a framework for driving the development of innovative IAHA products that will surpass the actual outcomes achieved by current viscosupplements in patients with mild-to-moderate KOA.
RESUMO
Background: Information about current practice in primary care-based management of atrial fibrillation (AF) can help to improve care quality. Purpose: To assess the epidemiology of AF and current patterns of treatment in order to identify therapeutic trends and aspects of current practice that may allow for care-gap identification. Methods: We scrutinized the anonymized records of the South Western Ontario database (SWO) collected between July 2002 and October 2008 for information about the characteristics and management of AF patients. Results: From a population of ~168,000 patients we identified 4922 patients with a diagnosis of AF (2.9%). The recorded prevalence of AF increased with age, from <2% at age <60 years to 6% in the age range 71-75 years and 10% at age ≥81 years. AF patients were characterized by an unfavourable cardiovascular risk profile including widespread hypertension (54% of all cases), coronary artery disease (37%) and heart failure (21%), many cases of which were advanced (New York Heart Association class III or IV). Diabetes (22%) and dyslipidaemia (31%) were also widely prevalent. The most frequently prescribed anti-arrhythmic drugs (AADs) were sotolol (n=798), amiodarone (n=712) and propafenone (n=451). Recorded use of flecainide was relatively low (n=175). Rate control-agents were being prescribed for 1838 patients, beta-blockers for 1311 patients and calcium channel blockers (CCBs) for 784 patients. Use of anticoagulants was higher among patients assigned to AADs than among those assigned to rate-control drugs (>25% vs. ~10%). Overall prescription rates for other concomitant medications were >50% for ACE inhibitors/ARBs, 30-35% for statins and beta-blockers, and 27-29% for diuretics, digoxin and CCBs. Conclusions: These Canadian patients with AF were relatively elderly and had multiple concomitant cardiovascular conditions and medications.
