Prolongation of the heart rate-corrected QT interval is associated with cardiovascular diseases: Systematic review and meta-analysis.

BACKGROUND: Conflicting findings have described the association between prolonged heart rate-corrected QT interval (QTc) and cardiovascular disease. AIMS: To identify articles investigating the association between QTc and cardiovascular disease morbidity and mortality, and to summarize the available evidence for the general and type 2 diabetes populations. METHODS: A systematic search was performed in PubMed and Embase in May 2022 to identify studies that investigated the association between QTc prolongation and cardiovascular disease in both the general and type 2 diabetes populations. Screening, full-text assessment, data extraction and risk of bias assessment were performed independently by two reviewers. Effect estimates were pooled across studies using random-effect models. RESULTS: Of the 59 studies included, 36 qualified for meta-analysis. Meta-analysis of the general population studies showed a significant association for: overall cardiovascular disease (fatal and non-fatal) (hazard ratio [HR] 1.68, 95% confidence interval [CI] 1.33-2.12; I2=69%); coronary heart disease (fatal and non-fatal) in women (HR 1.27, 95% CI 1.08-1.50; I2=38%; coronary heart disease (fatal and non-fatal) in men (HR 2.07, 95% CI 1.26-3.39; I2=78%); stroke (HR 1.59, 95% CI 1.29-1.96; I2=45%); sudden cardiac death (HR 1.60, 95% CI 1.14-2.25; I2=68%); and atrial fibrillation (HR 1.55, 95% CI 1.31-1.83; I2=0.0%). No significant association was found for cardiovascular disease in the type 2 diabetes population. CONCLUSION: QTc prolongation was associated with risk of cardiovascular disease in the general population, but not in the type 2 diabetes population.

Evaluating the Impact of Outpatient Multi-Dose Medication Packaging Service (MDMPS) on Medication Adherence and Clinical Outcomes.

BACKGROUND: There is limited understanding on the impact of the multidose medication packaging service (MDMPS). OBJECTIVES: The main objective of this study was to evaluate changes in medication adherence in patients using MDMPS compared to patients receiving standard medication packaging (control group). The other objectives were to determine the association between medication adherence and clinical outcomes, and to assess patients'/caregivers' perceptions toward MDMPS. METHODS: A retrospective cohort study was conducted among primary care patients in Singapore enrolled into MDMPS between 2012 and 2017. Eligible patients were taking at least five chronic medications, diagnosed with Hypertension, Hyperlipidemia and/or Type 2 Diabetes, with prescription records for at least six months before and after the index period. They were matched to control patients based on the type of comorbidities and medication adherence status. Medication Possession Ratio (MPR), glycated hemoglobin (HbA1c), blood pressure and low-density lipoprotein-cholesterol (LDL-C) of both groups were compared between baseline and at least six months post-index period. Interviewer-administered questionnaires were also conducted for MDMPS patients. RESULTS: The MPR of MDMPS patients (n = 100) increased by 0.37% (P < .001) compared to the control group (n = 100). MDMPS patients with diabetes had reduced HbA1c by 0.1% after six months (P = .022) but was not significant after 12 months. No significant changes were seen in blood pressure and LDL-C between both groups. At least 50% of patients were highly satisfied with MDMPS. CONCLUSION: MDMPS can improve medication adherence. Further studies are needed to understand its clinical impact.

A review on interventions to reduce medication discrepancies or errors in primary or ambulatory care setting during care transition from hospital to primary care.

INTRODUCTION: Transition of care from hospital to primary care has been associated with increased medication errors. This review article aims to examine the existing evidence on interventions to reduce medication discrepancies or errors in primary or ambulatory care setting during care transition from hospital to primary care. METHODS: We systematically reviewed the articles in primary or ambulatory care setting on patients with care transition that involved medication safety, discrepancy, or error as outcome assessment. Primary research articles were selected. Interventions in nursing homes or long-term care facilities were excluded from the review. RESULTS: We found 6 articles that met the inclusion criteria and 4 are prospective cohort study. The key players were pharmacists, nurse, and primary care physician. The interventions included care communication, medication reconciliation or review, and clarifying medication-related problems. CONCLUSION: There is evidence that interventions in primary care setting reduce medication discrepancies on patients with the transition of care from hospital to primary care setting. Only one randomized trial involving pharmacist-led medication reconciliation was done in an outpatient setting. More good-quality randomized controlled trials should be carried out to confirm the evidence.

When Paired HbA1c and Fasting Glucose Don't Match, Which is Telling the Truth?

This article explores the pitfalls in using glycated hemoglobin A (HbA1c) as a glycaemic monitoring tool in a patient with alpha-thalassemia intermedia. It includes the methods used for HbA1c measurement, such as charge-based or structure-based, presence of hemoglobin variants, ineffective erythropoiesis, concomitant iron deficiency and peripheral hemolysis. For such cases, the use of blood sugar profiles can be a useful alternative to monitor glycaemic control.