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  • 1
    Online Resource
    Online Resource
    Insulin Resistance Exacerbates Genetic Predisposition to Nonalcoholic Fatty Liver Disease in Individuals Without Diabetes
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Hepatology Communications Vol. 3, No. 7 ( 2019-07), p. 894-907
    Details
    In: Hepatology Communications, Ovid Technologies (Wolters Kluwer Health), Vol. 3, No. 7 ( 2019-07), p. 894-907
    Abstract: The accumulation of excess fat in the liver (hepatic steatosis) in the absence of heavy alcohol consumption causes nonalcoholic fatty liver disease (NAFLD), which has become a global epidemic. Identifying metabolic risk factors that interact with the genetic risk of NAFLD is important for reducing disease burden. We tested whether serum glucose, insulin, insulin resistance, triglyceride (TG), low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol, body mass index (BMI), and waist‐to‐hip ratio adjusted for BMI interact with genetic variants in or near the patatin‐like phospholipase domain containing 3 ( PNPLA3 ) gene, the glucokinase regulatory protein ( GCKR ) gene, the neurocan/transmembrane 6 superfamily member 2 ( NCAN/TM6SF2 ) gene , and the lysophospholipase‐like 1 ( LYPLAL1 ) gene to exacerbate hepatic steatosis, estimated by liver attenuation. We performed association analyses in 10 population‐based cohorts separately and then meta‐analyzed results in up to 14,751 individuals (11,870 of European ancestry and 2,881 of African ancestry). We found that PNPLA3‐ rs738409 significantly interacted with insulin, insulin resistance, BMI, glucose, and TG to increase hepatic steatosis in nondiabetic individuals carrying the G allele. Additionally, GCKR‐ rs780094 significantly interacted with insulin, insulin resistance, and TG. Conditional analyses using the two largest European ancestry cohorts in the study showed that insulin levels accounted for most of the interaction of PNPLA3‐ rs738409 with BMI, glucose, and TG in nondiabetic individuals. Insulin, PNPLA3 ‐rs738409, and their interaction accounted for at least 8% of the variance in hepatic steatosis in these two cohorts. Conclusion: Insulin resistance, either directly or through the resultant elevated insulin levels, more than other metabolic traits, appears to amplify the PNPLA3 ‐rs738409‐G genetic risk for hepatic steatosis. Improving insulin resistance in nondiabetic individuals carrying PNPLA3‐ rs738409‐G may preferentially decrease hepatic steatosis.
    Type of Medium: Online Resource
    ISSN: 2471-254X , 2471-254X
    URL: Article
    DOI: 10.1002/hep4.1353
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2881134-3
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  • 2
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    Change in Caregiver Health-Related Quality of Life From Before to Early After Surgery: SUSTAIN-IT Study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Circulation: Heart Failure Vol. 16, No. 8 ( 2023-08)
    Details
    In: Circulation: Heart Failure, Ovid Technologies (Wolters Kluwer Health), Vol. 16, No. 8 ( 2023-08)
    Abstract: Information about health-related quality of life (HRQOL) among caregivers of older patients with heart failure who receive heart transplantation (HT) and mechanical circulatory support (MCS) is sparse. We describe differences and factors associated with change in HRQOL before and early post-surgery among caregivers of older heart failure patients who underwent 3 surgical therapies: HT with pretransplant MCS (HT MCS), HT without pretransplant MCS (HT non-MCS), and long-term MCS. METHODS: Caregivers of older patients (60–80 years) from 13 US sites completed the EQ-5D-3 L visual analog scale (0 [worst]–100 [best] imaginable health state) and dimensions before and 3 and 6 months post-surgery. Analyses included linear regression, t tests, and nonparametric tests. RESULTS: Among 227 caregivers (HT MCS=54, HT non-MCS=76, long-term MCS=97; median age 62.7 years, 30% male, 84% White, 83% spouse/partner), EQ-5D visual analog scale scores were high before (84.8±14.1) and at 3 (84.7±13.0) and 6 (83.9±14.7) months post-surgery, without significant differences among groups or changes over time. Patient pulmonary hypertension presurgery (β=−13.72 [95% CI, −21.07 to −6.36]; P 〈 0.001) and arrhythmia from 3 to 6 months post-operatively (β=−14.22 [95% CI, −27.41 to −1.02]; P =0.035) were associated with the largest decrements in caregiver HRQOL; patient marital/partner status (β=6.21 [95% CI, 1.34–11.08]; P =0.013) and presurgery coronary disease (β=8.98 [95% CI, 4.07–13.89] ; P 〈 0.001) were associated with the largest improvements. CONCLUSIONS: Caregivers of older patients undergoing heart failure surgeries reported overall high HRQOL before and early post-surgery. Understanding factors associated with caregiver HRQOL may inform decision-making and support needs. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02568930.
    Type of Medium: Online Resource
    ISSN: 1941-3289 , 1941-3297
    URL: Article
    DOI: 10.1161/CIRCHEARTFAILURE.122.010038
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2428100-1
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  • 3
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    Abstract MP77: Will the World Health Organization’s “25 x 25” Goal Be Achieved? An Ecologic Time Trend Analysis of Relative and Absolute Premature Mortality Risk Due to Non-Communicable, Chronic Diseases
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation Vol. 129, No. suppl_1 ( 2014-03-25)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 129, No. suppl_1 ( 2014-03-25)
    Abstract: Objectives: To evaluate country-level time trends (1994-2011) in premature (30-69 years) mortality from non-communicable, chronic diseases (NCDs), including cardiovascular diseases, and to create forward projections to 2025 to evaluate the WHO’s goal of reducing the risk of premature mortality from NCDs by 25% by 2025. Methods: Using publicly available data from the WHO Mortality Database, we created annual estimates of risk of premature (30-69 years) NCD mortality (1994-2011). The sample included data from all countries reporting NCD mortality data from ≥2 years (n=116) and all countries reporting population estimates over the same years (n=135). We matched these datasets by country, year, division, administrative grouping and sex to reach a final sample of 60 countries (193 WHO Member States, 2011). We used ordinary least squares and log-linear Poisson regression models stratified by sex to evaluate the annual change in risk of premature mortality. We then created forward projections through 2025 using log-linear models. We used extrapolated premature mortality risk at 2025 and compared risk to 2010, with projected United Nations age- and sex-specific population estimates, to evaluate trends. Results: Among all included countries, the average (SD) risk of premature mortality from NCDs based on log-linear models in 1994 was 6.8 (4.2) and 3.9 (2.1) per 1,000 persons in men and women, respectively (Table 1). In 2010, men in lower-middle income countries had the highest rates of premature NCD mortality (7.2 [1.8] per 1,000), and women from high-income OECD countries had the lowest rates (2.0 [0.5] per 1,000). If recent trends continue, the median risk of premature mortality from NCDs will decrease by 25.1% (IQR 16.4, 37.0) by 2025. Conclusions: Among included countries, if recent trends in risk of premature death from NCDs continue to 2025, 50% of countries will achieve the WHO’s 25 x 25 goal. However, data are disproportionately missing from low- and middle-income countries, which appear less likely overall to achieve this goal.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.129.suppl_1.mp77
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 4
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    Abstract 13245: Clinical Correlates and Heritability of Cardiac Mechanics: Insights from the HyperGEN Study
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation Vol. 130, No. suppl_2 ( 2014-11-25)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 130, No. suppl_2 ( 2014-11-25)
    Abstract: Introduction: A genetic predisposition to abnormal cardiac mechanics may explain the familial predisposition to heart failure (HF). We hypothesized that indices of cardiac mechanics (speckle-tracking strain parameters and tissue velocities) are heritable traits. Methods: We performed speckle-tracking analysis on echocardiograms and measured global longitudinal, circumferential, and radial strain (GLS, GCS, GRS), early diastolic strain rate, and e’ velocities in the HyperGEN study, a family- and population-based study of hypertension (N=2058 [54% African American (AA)]). Additive genetic heritability estimates for cardiac mechanics were calculated by maximizing the likelihood variance components in SOLAR (ver.6) adjusted for age, sex, race, height, weight, systolic blood pressure (SBP), left ventricular (LV) mass, ejection fraction, reader, image quality, and institution. Results: Mean age was 51±14 years and HF risk factors were common: hypertension (56%), obesity (47%), and diabetes (16%). Clinical and conventional echocardiographic characteristics, including male gender, hypertension, elevated fasting glucose, higher body-mass index, and LV hypertrophy were all significantly associated with increased absolute GLS and septal e’ velocity (P 〈 0.05). After adjustment for covariates (and correlation within the same families), genetic contributions remained significant in GLS and septal e’ velocity in all participants, a finding which persisted in race-stratified analyses (Table). Conclusions: Echocardiographic measures of cardiac mechanics, particularly GLS and e’ velocity, are heritable traits, even after adjustment for clinical and cardiac structural factors (e.g., SBP and LV mass, respectively) that are known to be heritable and associated with cardiac mechanics. These data support the exploration of genetics of cardiac mechanics, which may provide insight into the molecular pathogenesis of LV dysfunction and HF.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.130.suppl_2.13245
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 5
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    Abstract P194: Polypill Eligibility For Patients With Heart Failure With Reduced Ejection Fraction In South India: A Secondary Analysis Of A Prospective, Interrupted Time Series Study
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 145, No. Suppl_1 ( 2022-03)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 145, No. Suppl_1 ( 2022-03)
    Abstract: In India, data from large HF registries has demonstrated significantly lower 5-year mortality rates for patients with HFrEF discharged on guideline-directed medical therapy (GDMT), revealing an important target for intervention to improve clinical outcomes. Hospital-based quality improvement initiatives to increase rates of GDMT at hospital discharge have had limited effect, suggesting additional strategies are needed to improve GDMT rates in HFrEF patients. Polypills for HFrEF have been proposed as an implementation strategy to simplify the current treatment paradigm for undertreated patients with HFrEF. However, the potential effect of HFrEF polypills on increasing GDMT rates in target populations is unknown. The objective of this secondary analysis is to describe eligibility for a potential HFrEF polypill in the context of GDMT prescription rates for South Indian patients with HFrEF. We analyzed data from a prospective, interrupted time series study in 2018 (HFQUIK) that evaluated the effect of a quality improvement intervention on process of care measures and clinical outcomes in patients hospitalized with acute HFrEF in 8 hospitals in South India. The primary outcome was prescription of GDMT defined as an ACE-I or ARB or ARNi, along with a beta-blocker and aldosterone antagonist. Participants were eligible for a HFrEF polypill containing GDMT if LVEF 〈 40%, HR ≥50 beats/min, creatinine ≤2.5 mg/dL in men and ≤2 mg/dL in women, and potassium 〈 5 mEq/L. We included 937 participants with HFrEF (n = 494 control period, n = 443 intervention period). Prescription rates of ACE-I or ARB or ARNi, beta-blocker, and aldosterone antagonists were low on hospital admission and increased at hospital discharge. The prescription of GDMT increased from 5.5% (27/494) to 28.8% (127/494) in the control period and from 4.5% (20/443) to 42.3% (171/443) in the intervention period. Notably, more than 80% of participants were eligible for a HFrEF polypill at hospital discharge during both control (364/494) and intervention (336/443) periods, with similar rates among female and male participants. In this study, than 80% of patients were eligible for a HFrEF polypill at discharge. Although the HF QUIK quality improvement intervention increased rates of GDMT at hospital discharge, routine administration of a HFrEF polypill could further increase this rate and improve adherence by 44% (95% CI: 26% to 65%) in a population that remains undertreated despite targeted quality improvement interventions. Availability of multiple HFrEF polypill doses could prioritize safety and tolerability with low-dose initiation and subsequent titration to higher-dose polypills. This analysis suggests a simplified polypill-based management strategy could be transformative for closing the treatment gap in HFrEF inequities in India and globally.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.145.suppl_1.P194
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 6
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    Abstract 12804: Knowledge of Cardiovascular Disease Risk in Young Women of Reproductive Age: A Cross-Sectional Survey-Based Study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_1 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
    Abstract: Introduction: Knowledge of cardiovascular disease (CVD) as the leading cause of death (LCOD) among women in the United States is declining. Young women who experience an adverse pregnancy outcome (APO) are at increased risk for CVD, but knowledge of CVD risk has not been well characterized in this population in the perinatal period. Our objective was to examine knowledge of CVD risk in postpartum women and to determine whether risk perception differs based on experience of APO. Methods: A cross-sectional study was conducted among postpartum individuals who had a live birth at a single high-volume quaternary care center between 1/1/20 and 7/1/20. Knowledge of CVD risk was assessed through a self-administered online survey adapted from the American Heart Association Survey of Women’s CVD Awareness. Survey data were collected between 3/1/21 and 4/18/21. We examined differences in knowledge of CVD risk factors based upon self-reported APO status. Results: Of the 5,612 eligible individuals contacted, 13% completed the survey. Among respondents, the majority identified as White (70%) with a mean age of 34 + 4.2 years, and 25% reported an APO. Similar proportions of women with (62%) and without (62%) an APO identified CVD as the LCOD in women. There was no significant difference in knowledge of traditional or pregnancy-specific CVD risk factors by APO status ( TABLE ). Women who experienced an APO were more likely to report intention to contact a healthcare professional regarding personal CVD risk compared with women who did not. Conclusions: Gaps remain in knowledge of CVD risk factors among young women, in whom primary prevention of CVD may be most beneficial over the lifespan. Heterogeneity in knowledge deficits related to APO subtypes as CVD risk factors present a unique opportunity for targeted education at a time when healthcare engagement is high. Given the modest response rate to this survey, awareness may be even lower in the general population.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_1.12804
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 7
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    Disparities in Cardiovascular Research Output and Citations From 52 African Countries: A Time‐Trend, Bibliometric Analysis (1999–2008)
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Journal of the American Heart Association Vol. 4, No. 4 ( 2015-04-22)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 4, No. 4 ( 2015-04-22)
    Abstract: Cardiovascular research output and citations of publications from Africa have historically been low yet may be increasing. However, data from the continent are limited. Methods and Results To evaluate the cardiovascular research output and citations from 52 African countries between 1999 and 2008, we created a bibliometric filter to capture cardiovascular research articles published in the Web of Knowledge based on specialist journals and title words. Two coauthors with expertise in cardiovascular medicine tested and refined this filter to achieve 〉 90% precision and recall. We matched retrieved records with their associated citation reports and calculated the running 5‐year citation count postpublication, including the year of publication. Publications from Africa were identified by author addresses. South Africa published 872 cardiovascular research papers, Egypt 393, Tunisia 264, and Nigeria 192 between 1999 and 2008. The number of publications increased over the time period for a small number of countries (range 0.1 to 4.8 more publications per year by fractional count). Most countries' citations were low ( 〈 50), but citations were greatest for South Africa (7063), Egypt (2557), Tunisia (903), and Nigeria (540). The same countries had the greatest annual increase in 5‐year citation index values: 65 (95% CI : 30, 99) for South Africa, 46 (34, 58) for Egypt, 22 (15, 28) for Tunisia, and 8 (2, 14) for Nigeria. The burden of cardiovascular disease had a weak and inconsistent relationship to cardiovascular publications ( r 2 =0.07, P =0.05). Greater gross domestic product was associated with more cardiovascular publications in 2008 ( r 2 =0.53, P 〈 0.0001). Conclusions The increases in cardiovascular research outputs from Africa are concentrated in a few countries. The reasons for regional differences in research outputs require further investigation, particularly relative to competing disease burdens. Higher prioritization of cardiovascular research funding from African countries is warranted.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.114.001606
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 2653953-6
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  • 8
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    Baseline Longitudinal Strain Predicts Recovery of Left Ventricular Ejection Fraction in Hospitalized Patients With Nonischemic Cardiomyopathy
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Journal of the American Heart Association Vol. 7, No. 20 ( 2018-10-16)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. 20 ( 2018-10-16)
    Abstract: Heart failure ( HF ) with “recovered” ejection fraction ( HF rec EF ) is an emerging phenotype, but no tools exist to predict ejection fraction ( EF ) recovery in acute HF . We hypothesized that indices of baseline cardiac structure and function predict HF rec EF in nonischemic cardiomyopathy and reduced EF . Methods and Results We identified a nonischemic cardiomyopathy cohort with EF 〈 40% during the first HF hospitalization (n=166). We performed speckle‐tracking echocardiography to measure longitudinal, circumferential, and radial strain, and the average of these measures (myocardial systolic performance). HF rec EF was defined as follow‐up EF ≥40% and ≥10% improvement from baseline EF . Fifty‐nine patients (36%) achieved HF rec EF (baseline EF 26±7%; follow‐up EF 51±7%) within a median of 135 (interquartile range 58‐239) days after the first HF hospitalization. Baseline demographics, biomarker profiles, and comorbid conditions (except lower chronic kidney disease in HF rec EF ) were similar between HF rec EF and persistent reduced‐ EF groups. HF rec EF patients had smaller baseline left ventricular end‐systolic dimension (3.6 versus 4.8 cm; P 〈 0.01), higher baseline myocardial systolic performance (9.2% versus 8.1%; P =0.02), and improved survival (adjusted hazard ratio 0.27, 95% confidence interval 0.11, 0.62). We found a significant interaction between baseline left ventricular end‐systolic dimension and absolute longitudinal strain. Among patients with left ventricular end‐systolic dimension 〉 4.35 cm, higher absolute longitudinal strain (≥8%) was associated with HF rec EF (unadjusted odds ratio=3.9, 95% CI )confidence interval 1.2, 12.8). Incorporation of baseline indices of cardiac mechanics with clinical variables resulted in a predictive model for HF rec EF with c‐statistic=0.85. Conclusions Factors associated with achieving HF rec EF were specific to cardiac structure and indices of cardiac mechanics. Higher baseline absolute longitudinal strain is associated with HF rec EF among nonischemic cardiomyopathy patients with reduced EF and larger left ventricular dimensions.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.118.009841
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 9
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    Prognostic Utility and Clinical Significance of Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction : Importance of Left Atrial Strain
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Circulation: Cardiovascular Imaging Vol. 9, No. 3 ( 2016-03)
    Details
    In: Circulation: Cardiovascular Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 9, No. 3 ( 2016-03)
    Abstract: Left atrial (LA) enlargement is associated with adverse events in heart failure with preserved ejection fraction (HFpEF). However, the role of LA mechanics (ie, LA strain measures) in HFpEF has not been well studied. We hypothesized that in HFpEF, reduced (worse) LA strain is a key pathophysiologic abnormality and is a stronger correlate of adverse events than left ventricular or right ventricular longitudinal strain. Methods and Results— We evaluated baseline LA function in 308 patients with HFpEF who were followed up longitudinally for adverse outcomes. All patients underwent speckle-tracking echocardiography for measurement of left ventricular longitudinal strain, right ventricular free wall strain, and LA booster, conduit, and reservoir strains. The clinical and prognostic significance of left ventricular, right ventricular, and LA strain measures was assessed by regression analyses. The mean age was 65±13 years, 64% were women, 26% had atrial fibrillation, and LA enlargement was present in the majority of patients (67%). Decreased LA reservoir strain was associated with increased pulmonary vascular resistance ( P 〈 0.0001) and decreased peak oxygen consumption ( P =0.0001). Of the left ventricular, right ventricular, and LA strain measures, LA reservoir strain was the strongest correlate of adverse events and was independently associated with the composite outcome of cardiovascular hospitalization or death (adjusted hazard ratio per 1-SD decrease in LA strain, 1.54; 95% CI, 1.15–2.07; P =0.006). Conclusions— Abnormal indices of LA mechanics (particularly LA reservoir strain) are powerful clinical and prognostic factors in HFpEF. Unloading the LA and augmentation of LA function may be important future therapeutic targets in HFpEF. Registration Information— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01030991.
    Type of Medium: Online Resource
    ISSN: 1941-9651 , 1942-0080
    URL: Article
    DOI: 10.1161/CIRCIMAGING.115.003754
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 2440475-5
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  • 10
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    Availability, Sales, and Affordability of Tobacco Cessation Medicines in Kerala, India
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 10, No. 11 ( 2017-11)
    Details
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 10, No. 11 ( 2017-11)
    Abstract: India is the world’s second largest consumer of tobacco, but tobacco cessation remains uncommon due, at least in part, to underutilization of cessation pharmacotherapy. We evaluated the availability, sales, and affordability of nicotine replacement therapy, bupropion, and varenicline in the South Indian state of Kerala to understand potential reasons for underutilization. Methods and Results— From November 2016 to April 2017, we collected data on availability, inventory, and pricing of cessation medication through a cross-sectional survey of 199 public, semiprivate (Karunya), and private pharmacies across 5 districts in Kerala using World Health Organization/Health Action International methodology. Revenue and sales data were obtained from the latest Pharmatrac medication database. We assessed affordability using individual- and household-level income and expenditure data collected from November 2014 to November 2016 through the Acute Coronary Syndrome Quality Improvement in Kerala randomized trial. Cessation medications were not available in public hospitals (0%, n=58) nor in public specialty centers (0%, n=10) including those designated to provide cessation services. At least 1 cessation medicine was available at 63% of private pharmacies (n=109) and 27% of Karunya (semiprivate) pharmacies (n=22). Among the 75 pharmacies that stocked cessation medications, 96% had nicotine replacement therapy, 28% had bupropion, and 1% had varenicline. No outlets had sufficient inventory for a patient to purchase a 12-week treatment regimen. There were an estimated 253 270 treatment regimens sold throughout India and 14 092 in Kerala in 2013 to 2014. Treatment regimens cost 1.9 to 13.0× the median amount spent on smoked tobacco and between 8% and 52% of nonsubsistence income. Conclusions— Tobacco cessation medications are unavailable in the Kerala public sector and have limited availability in the private and semiprivate sectors. When available, medications are unaffordable for most patients. Addition of tobacco cessation medication onto national and state essential medicines lists may help increase access. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT02256657.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    URL: Article
    DOI: 10.1161/CIRCOUTCOMES.117.004108
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2453882-6
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