Background There is a growing interest in the intersection of heart failure (HF) and frailty; however, estimates of the prevalence of frailty in HF vary widely. The purpose of this paper was to quantitatively synthesize published literature on the prevalence of frailty in HF and to examine the relationship between study characteristics (i.e. age and functional class) and the prevalence of frailty in HF. Methods The prevalence of frailty in HF, divided into Physical Frailty and Multidimensional Frailty measures, was synthesized across published studies using a random-effects meta-analysis of proportions approach. Meta-regression was performed to examine the influence of age and functional class (at the level of the study) on the prevalence of frailty. Results A total of 26 studies involving 6896 patients with HF were included in this meta-analysis. Despite considerable differences across studies, the overall estimated prevalence of frailty in HF was 44.5% (95% Confidence Interval, 36.2%–52.8%; z = 10.54; p < 0.001). The prevalence was slightly lower among studies using Physical Frailty measures (42.9%, z = 9.05; p < 0.001) and slightly higher among studies using Multidimensional Frailty measures (47.4%, z = 5.66; p < 0.001). There were no significant relationships between study age or functional class and prevalence of frailty. Conclusions Frailty affects almost half of patients with HF and is not necessarily a function of age or functional classification. Future work should focus on standardizing the measurement of frailty and on broadening the view of frailty beyond a strictly geriatric syndrome in HF.

BackgroundAntibiotics resistance is a serious problem around the world, which has been increasing in the last century due to misuse of antibiotics. Recently, Saudi Arabia enforced the Executive Regulations of Health Practice Law that prohibits dispensing antibiotics without prescription.Aim(1) To assess the association between the knowledge and attitude toward the recent enforcement of the antibiotic restriction Law and the antibiotic use among Saudi population.(2) To assess the pattern of antibiotic use before and after the enforcement of the Law.MethodAn online cross-sectional study was conducted among residents of Saudi Arabia.ResultsThe study was carried out among 570 Saudi participants; the result shows no considerable difference before and after law enforcement in purchasing and use of antibiotics. During the six months before the law implementation, antibiotics were obtained by 42 (7%) through purchase from the pharmacy without a prescription, 23 (4%) through remains of previously used containers, and 7 (1%) through a relative or a friend; while during the six months after the law implementation it was 31 (5%), 22 (4%) and 7 (1%), respectively. Only 48% agreed that they always received advice from a doctor, nurse or pharmacist on how to use your antibiotics. 32% have no knowledge about antibiotic resistance or drug resistance or antibiotic-resistant bacteria. More than two third (75%) were aware of the recent enforcement of the law that prohibits dispensing antibiotics without prescription. Among the participants, 91 (16%), 285 (50%) and 194 (34%) were expressed negative, neutral and positive attitude towards the law, respectively.ConclusionIn spite of the recent enforcement of the Law, there is still misuse of antibiotics, which indicate need for educational programs and campaigns to improve the knowledge of the population.

Findings from our study indicate that compared with propensity score-matched controls, stroke survivors engage in poorer health behaviors with the exception of alcohol consumption.

BackgroundDepression is one of the most common psychiatric conditions among stroke survivors and is associated with several negative health outcomes. However, little is known about the depression treatment patterns among stroke survivors. The objective of this study was to examine national-level prevalence, patterns and predictors of depression treatment among community-dwelling stroke survivors.MethodsThis study adopted a retrospective, cross-sectional study design using multiple years of Medical Expenditure Panel Survey (MEPS) (2002–2012) data. The study population consisted of older adults (age ≥ 50 years) who (i) were stroke survivors (ICD-9-CM codes of 430–438), (ii) did not die during the calendar year, and (iii) had co-occurring depression (ICD-9-CM code of 296.xx, or 311.xx). Depression treatment, identified by antidepressant medication and/or psychotherapy use, was the dependent variable of this study. Multinomial logistic regression analysis was conducted to examine the association of individual level factors with depression treatment among stroke survivors with co-occurring depression.ResultsThe final study sample consisted 370 (unweighted) community-dwelling older adults with self-reported stroke and depression. The prevalence of co-occurring depression among stroke survivors was 22.03% [95% Confidence Interval (CI) 19.7–24.4%]. An overwhelming majority (87.6%) of stroke survivors with co-occurring depression reported some form of depression treatment. Antidepressants only and combination therapy was reported by 74.8% (95% CI, 71.6–78.0%] and 12.8% (95% CI, 10.5–15.1%) by stroke survivors with co-occurring depression respectively. Approximately, 61% of stroke survivors with co-occurring depression reported using SSRIs, followed by SNRIs (15.2%), miscellaneous antidepressants (12.1%), TCAs (9.8%), phenylpiperazine antidepressants (5.2%), and tetracyclic antidepressants (4%). Sertraline (15.8, 95% CI, 12.7–19.0%) had the highest reported use among individual antidepressants.ConclusionsVast majority (nearly 90%) of the study sample received some form of depression treatment and several individual level factors (such as age, education) were associated with the report of depression treatment use. Future longitudinal studies are warranted to assess the comparative treatment benefits of antidepressants, psychotherapy and their combination. Healthcare providers should carefully assess the risks and benefits of antidepressant (such as SSRIs or TCAs) use in this vulnerable population prior to their use.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1723-x) contains supplementary material, which is available to authorized users.

Poor medication adherence is a global problem that compromises the benefit of a given treatment. 1 It also increases the rate of mortality, morbidity and healthcare costs. 2 In the United States, direct medical cost of chronic diseases reached a trillion dollar, while nonadherence costs over $170 billion annually. 2,3 Furthermore, in transplant recipients, the non-adherence to immunosuppressants results in 1319 cases of renal transplant failure annually. 4 The achievement of the total benefit from medication is determined by patient adherence to their treatment regimens. 5 Adherence is defined as the "extent to which a patient acts in accordance with the prescribed interval and dose and dosing regimen". 6 Half of the prescribed medications for chronic diseases are not taken as prescribed by their healthcare providers. 2 Hypertension is one of the chronic medical conditions that affects a great percentage of people all over the globe. In 2000, the estimated number of adults with hypertension was 972 million and