Objective: Levosimendan is a novel drug often used to treat heart failure. We aimed to explore the effects of levosimendan preconditioning on left ventricular remodeling (LVR) after myocardial reperfusion in acute myocardial infarction (AMI) patients receiving the percutaneous coronary intervention (PCI). Methods: A total of 258 AMI patients treated from January 2018 to September 2020 were randomly divided into control and observation groups. Based on conventional drug therapy, levosimendan was given 30 min before PCI for the observation group, and dobutamine was intravenously injected for the control group. Baseline data, thrombolysis in myocardial infarction (TIMI) blood flow grade, myocardial injury markers, and LVR indices were compared, and the influencing factors for LVR were analyzed. Results: After treatment, various degrees of blood perfusion were found, and the TIMI grade was better than that before treatment in both groups (P < .05). The levels of aspartate aminotransferase, creatine kinase-MB, cardiac troponin T, and brain natriuretic peptide (BNP) declined in both groups, more significantly in the observation group (P < .05). Left ventricular end-systolic diameter, left ventricular end-diastolic diameter and left ventricular end-diastolic volume declined, whereas left ventricular ejection fraction rose in both groups, more significantly in the observation group (P < .05). Age and BNP were risk factors for LVR, whereas levosimendan preconditioning was a protective factor (P < .05). Conclusion: Levosimendan preconditioning can protect cardiac function and promote the recovery of the left ventricular structure. Age and BNP are risk factors for LVR after myocardial reperfusion in AMI patients undergoing PCI, and levosimendan preconditioning is a protective factor.

Dual antiplatelet therapy (DAPT) was currently recommended for transcatheter aortic valve implantation (TAVI) postoperative management in clinical application. However, POPular-TAVI trial showed DAPT increased the incidence of adverse events compared to single antiplatelet therapy (SAPT). Herein, we performed a meta-analysis to investigate the effect of SAPT versus DAPT on the adverse events after TAVI. Eleven studies were available from PubMed, Embase, Cochrane Library, and Web of Science from inception to April 1, 2021. The pooled effect size was presented as relative risk (RR) with 95% confidence intervals (CIs). The sensitivity analysis was used to assess the stability of analysis results, and Begg's test was applied to evaluate the publication bias. The Cochran Q test and the I 2 statistic were used to evaluate the heterogeneity, and the source of heterogeneity was explored by meta-regression. A total of 4804 patients were obtained, with 2257 in SAPT group and 2547 in DAPT group.Compared to the DAPT, SAPT was associated with the decreased risk of all-cause bleeding (RR: 0.51, 95% CI: 0.44-0.61), major bleeding (RR: 0.53, 95% CI: 0.32-0.86), and minor bleeding (RR: 0.58, 95% CI: 0.34-0.98). There were no significant differences in mortality and myocardial infarction events, stroke events, and acute kidney injury between the two groups. SAPT was superior to DAPT in decreasing all-cause bleeding, major bleeding, and minor bleeding, suggesting that SAPT could be preferentially recommended for TAVI postoperative management in most patients without another indication for DAPT and oral anticoagulation.

nism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial showed that tolvaptan, combined with standard therapy, improved many heart failure signs and symptoms without serious adverse events. This study evaluated the hospital resource utilization associated with tolvaptan usage among heart failure (HF) patients with hyponatremia based on the EVEREST trial. METHODS: A cost offset model was constructed to evaluate the impact of tolvaptan on hospital resource utilization among HF patients. The Healthcare Cost and Utilization Project (HCUP) 2008 Nationwide Inpatient Sample (NIS) database was used to estimate hospitalization length of stay (LOS) and hospital cost, for HF-associated diagnosis related group hospitalizations (DRG) of adult patients (age Ն18 years). EVEREST trial data for patients with hyponatremia were used to estimate the reduction of LOS associated with tolvaptan vs. placebo. RESULTS: Among EVEREST trial HF patients with hyponatremia (Ͻ135 mEq/L), tolvaptan patients had a shorter hospitalization LOS than placebo patients (9.72 vs. 11.44 days, respectively), with a relative LOS reduction of 15%. 933,189 HF-associated DRG hospitalizations were identified from the HCUP NIS database. The mean LOS was 4.8 days with mean total hospital costs of $7,545, and mean daily hospital costs of $1,562. Using an inpatient tolvaptan treatment duration of 3 days with a daily wholesale acquisition cost of $250, the cost offset model estimated a LOS reduction among US HF hospitalizations of 0.73 days with a hospital cost reduction averaging $1,134 per HF admission. The cost neutral breakeven mean duration of tolvaptan inpatient therapy is 4.54 days. CONCLUSIONS: Based on the EVEREST trial, tolvaptan is associated with a shorter hospitalization LOS than placebo among hyponatremic HF patients, resulting in an estimated mean hospital cost reduction of $1,134 per admission in the US. PCV38

OBJECTIVES: Determine if Medicare Part D beneficiaries who received telephone MTM services had:1) Decreased medication/health-related problems (MHRPs); 2) Improved medication adherence; and 3) Decreased total Part D drug costs when compared to a control group. METHODS: Part D beneficiaries from a Texas health plan participated. The Andersen Model was the theoretical framework. Independent variables were: predisposing factors (age, gender, and race); and need factors (number of medications and chronic diseases and medication regimen complexity (MRC). The health behavior (intervention) was MTM utilization. Outcomes were change (from baseline to 12-month follow-up) in: 1) Number of MHRPs; 2) Medication adherence measured by the medication possession ratio (MPR); and 3) Total drug costs. Descriptive and inferential statistical analyses were conducted. RESULTS: The intervention (nϭ60) and control (nϭ60) groups were not statistically different regarding age (71.2Ϯ7.5 vs.73.9Ϯ8.0), medications (13.0Ϯ3.2 vs.13.2Ϯ3.4), chronic diseases (6.5Ϯ2.3 vs.7.0Ϯ2.1) or MRC [(21.5 (range 8 -43) vs.22.8 (range 9 -42.5)], respectively. The majority (51%) were male in the intervention group but only 28% were male in the control group (pϭ0.009). At baseline, 4.8Ϯ 2.7 (intervention group) and 9.1Ϯ 2.9 (control group) MHRPs were identified and 2.2Ϯ2.0 and 7.3Ϯ3.0 MHRPs remained at the 12-month follow-up, respectively. Multivariate regression revealed that MHRPs decreased significantly (pϭ0.0120) among the intervention group when compared to the control group. There were no significant predictors of change in MPR. Total drug costs (change from baseline to follow-up) decreased by $588Ϯ$2,086 in the intervention group and increased by $207Ϯ$1,752 in the control group. A t-test indicated the cost difference between the 2 groups was significant (pϭ0.03), but the multivariate regression did not indicate significant predictors. CONCLUSIONS: A telephone MTM program positively impacted MHRPs. Unadjusted cost comparisons also showed cost savings among the intervention group. Future research should focus on understanding predictors that impact adherence and cost-related MTM outcomes.