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Guidelines Update: Preventive Treatments for Migraine

Guidelines Update: Preventive Treatments for Migraine

About 38% of people who suffer from migraine could benefit from preventive treatments, but less than one-third currently uses them. Some analyses have shown that migraine attacks can be reduced by more than half with preventive therapies. In 2000, the American Academy of Neurology (AAN) published guidelines for migraine prevention. In the April 24, 2012 issue of Neurology, the AAN and the American Headache Society issued updated guidelines to account for new evidence. One set of guidelines was developed specifically for prescription products, while another was created for OTC drugs and complementary therapies. In each guideline, the safety and efficacy of pharmacologic therapies for migraine prevention was addressed. The reviews addressed the strength of evidence backing a given drug’s superiority relative to placebo. Prescription Drugs for Migraine Among prescription medications, several β-blockers (metoprolol, propranolol, and timolol) and seizure drugs (divalproex sodium, sodium valproate, and topiramate) established “proven efficacy” for migraine prevention based on clinical research. One selective serotonin receptor agonist (frovatriptan) was also proven effective. It’s recommended that clinicians consider offering these medications to migraineurs to reduce the frequency and severity of attacks.             Topiramate was elevated to a Level A recommendation (indicating “proven efficacy”) on the strength of five randomized trials. Other drugs that had previously been used for migraine prevention were downgraded from higher recommendations in 2000 because the current evidence failed to clearly support their efficacy. OTCs & Complimentary Therapies for Migraine Petasites, also known as butterbur, were shown to be effective in preventing migraine. Several NSAIDs were found to be “probably effective,” including fenoprofen, ibuprofen, ketoprofen, naproxen and naproxen sodium,...

Improving Survival After Heart Failure

Heart failure (HF) is among the leading causes of hospitalization in the United States, afflicting more than 5.8 million men and women each year. The disease has been associated with substantial morbidity, mortality, and healthcare expenditures. The 5-year mortality rate for HF has been estimated at more than 50%, and roughly $40 billion is spent annually in costs related to HF. Previous studies have shown that there are gaps, variation, and disparities in the use of evidence-based, guideline-recommended therapies for HF. Regardless of the clinical setting, many eligible HF patients do not receive one or more of the therapies that have been proven to be effective in reducing all-cause mortality in clinical trials and analyses. Non-adherence to recommended HF therapies can significantly reduce quality of life and lifespan in sufferers with the disease. Examining Benefits of Proven HF Therapies A study published in the February 21, 2012 Journal of the American Heart Association: Cardiovascular and Cerebrovascular Diseases evaluated the individual and incremental benefits of guideline-recommended therapies. “While certain therapies are recommended for HF patients in national guidelines from the American College of Cardiology and the American Heart Association, our study was the first to examine the specific incremental contribution of each of these therapies in improving survival when combined in a real-world clinical practice,” says Gregg C. Fonarow, MD, who was the lead author on the investigation. The study by Dr. Fonarow and colleagues utilized a nested case-control design that included HF patients who were enrolled in the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) cohort. The analysis involved 1,376...
Analyzing Poor Medication Adherence After MI

Analyzing Poor Medication Adherence After MI

Approximately, 1.5 million cases of myocardial infarction (MI) occur each year. An estimated 5% to 10% of patients who survive an MI die within the first year after the index event, and half are rehospitalized. Studies have demonstrated that medications such as aspirin, β-blockers, ACE inhibitors, and statins taken after MI are associated with improved short- and long-term outcomes, providing protection against subsequent cardiovascular events. Despite proven benefits, a large proportion of patients who have had an MI appear to discontinue use of their prescribed medications over time. Most medications should be taken indefinitely, but long-term data on factors affecting medication adherence are lacking. New Data on Medication Adherence In a study published in the October 2009 American Journal of Medicine, my colleagues and I published an analysis assessing patients hospitalized with MI from 1997 to 2006 to determine adherence to statins, β-blockers, and ACE inhibitors/angiotensin receptor blockers (ARBs). The study also looked at factors that appeared to be associated with improved adherence. Data demonstrated that adherence to guideline-recommended medications decreased over time, with 3-year medication continuation rates of 44%, 48%, and 43% for statins, β-blockers, and ACE inhibitors/ARBs, respectively. Our findings illustrated that many patients discontinued use of prescribed cardioprotective medications after MI, with less than half continuing medications 3 years after their MI. Results were particularly striking because the study included patients who were well-insured with relatively low out-of-pocket expenses for prescription drugs. Considering the insurance status of the patients assessed, adherence is presumably even worse among the general population. Assessing Adherence Factors A potential cause of poor medication adherence after MI may be a “knowledge translation...

Atrial Flutter: Current Concepts & Management Strategies

Typical atrial flutter (AFL), a condition which affects an estimated 200,000 new patients annually, has been defined as a pattern of regular tachycardia originating in the right atrium with an atrial rate of 240 beats/minute or higher. The current prevalence of AFL is high and is projected to increase considerably by 2050. Although not as common as atrial fibrillation, AFL can be a chronic condition. If left untreated, AFL can lead to debilitating symptoms, including shortness of breath, palpitations, dizziness, fainting, chest tightness, fatigue, and weakness. It can significantly impair quality of life and is associated with impaired cardiac output, atrial thrombus formation, and stroke. With proper treatment, however, AFL is rarely life threatening and symptoms can usually be managed effectively. “Atrial flutter is a common condition which should be treated appropriately to alleviate symptoms and prevent clot formation,” says Angelo Biviano, MD, MPH. Dr. Biviano adds that AFL in some patients can be associated with atrial fibrillation, and proper diagnosis and treatment is imperative. Research suggests that elimination of AFL may delay but not prevent fibrillation. Therefore, proper diagnosis and treatment of AFL is imperative. “The good news is that several treatment strategies exist for AFL,” says Dr. Biviano. “Consideration of patients’ medical history as well as their preferences will help guide treatment strategies for patients.” Identifying Causes AFL may be caused by abnormalities or diseases of the heart as well as diseases elsewhere in the body that affect the heart. These include diseases of the heart valves, especially the mitral valve, and chamber enlargement/hypertrophy. Diseases of the heart that have been linked to AFL include ischemia, atherosclerosis,...
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