Aims: In recent large trials, sacubitril/valsartan demonstrated favorable effects in patients with HF. However, many patients do not achieve the target dose of treatment. This study investigated the factors linked to up-titration of sacubitril/valsartan in patients with heart failure and preserved ejection fraction (HFpEF). Methods: Using a multicenter retrospective database, 204 consecutive patients with HFpEF (left ventricular ejection fraction ≥ 40%) who were treated with sacubitril/valsartan between October 2020 and March 2022 were analyzed. Up-titration was defined as an increase in dosage above 24/26 mg BID beyond 12 weeks after the initiation of sacubitril/valsartan. Results: Among the patients, 55% underwent up-titration, and 8% discontinued the drug. The baseline systolic blood pressure (SBP) was higher in patients with up-titration than in those with no up-titration; SBP values similar to that at baseline were observed between the 2 groups at 2 to 4 weeks and at 12 weeks after the commencement of sacubitril/valsartan treatment. The majority of those who discontinued sacubitril/valsartan did so because of hypotension. The multivariable logistic regression model showed that a history of hypertension, history of atrial fibrillation, baseline SBP, and baseline estimated glomerular filtration rate <60 mL/min/1.73 m2 were associated with sacubitril/valsartan up-titration. Conclusion: Approximately half of all patients did not undergo up-titration, and 8% of those with HFpEF discontinued the sacubitril/valsartan therapy. For aggressive up-titration and continuation of sacubitril/valsartan, patients with lower baseline SBP, renal dysfunction, absence of a history of hypertension, and presence of atrial fibrillation may require more careful monitoring.
Background: Rapid coronavirus 2019 (COVID-19) testing in symptomatic cases is extremely important for preventing the spread of COVID-19 infection and early therapeutic intervention. In contrast, whether symptomatic patients are tested depends largely on their health literacy, interpretation, and knowledge of COVID-19. We aimed to investigate the rate of COVID-19 testing avoidance despite having common cold symptoms in patients with cardiovascular disease and examine factors related to testing avoidance. Methods: A large-scale epidemiological questionnaire survey, the Japan COVID-19 and Society Internet Survey 2022 (JACSIS), was conducted online from April to May 2022. The rate of COVID-19 testing avoidance was investigated in patients aged 20 to 80 years with cardiovascular risk factors (hypertension, dyslipidemia, or diabetes) or a history of cardiovascular disease (angina, myocardial infarction, or stroke), only those exhibiting common cold symptoms during the 2 months in the survey. Results: Of the 1,565 eligible patients, 58% (909 patients) did not undergo COVID-19 testing. Multivariate analysis revealed that older age, obesity, non-walking regularly, long sedentary time, eating alone, frequent snacking, and having received 4 COVID-19 vaccinations were independently associated with testing avoidance. Conclusions: In the chronic phase of the COVID-19 pandemic, prompt COVID-19 testing at the time of symptomatic disease is important, and strategies to reduce testing hesitancy should be considered.
BackgroundFew effective tools have been identified that facilitate the initiation of antihypertensive medications in patients with untreated hypertension. To determine whether a mobile health (mHealth) application facilitates the initiation of antihypertensive medications in patients with untreated hypertension.MethodsWe analyzed a large, longitudinal, integrated database mainly comprising middle-aged, working people and their families. The database contained health checkup data, health insurance claims data, and mHealth app data. The mHealth app, kencom, is used to manage daily life logs (i.e. weight, number of steps) and to provide health information tailored to customers. Patients with untreated hypertension were defined using the baseline health checkup data. A multivariable logistic regression analysis was performed to examine the association between use of the mHealth app and the initiation of antihypertensive medications.ResultsAmong 50 803 eligible patients (mean age, 49 years; 78 % male) with a median follow-up period of 3.0 years. The rate of initiation of antihypertensive medication was 23.4 % vs. 18.5 % (p < 0.0001), which was significantly higher in the mHealth application group (n = 14 879) than in the non-user group (n = 35 924). Multivariable analysis revealed that usage of the mHealth app was associated with initiated antihypertensive medications (odds ratio 1.43, 95 % confidence interval 1.36–1.50).ConclusionIn patients with untreated hypertension, the use of the mHealth app, which was not dedicated to hypertension treatment, was associated with the initiation of antihypertensive medications.
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