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Prior studies have reported improvements in population-level risk factor burden and cardiovascular disease (CVD) outcomes using polypills for CVD risk reduction. However, a comprehensive assessment of the impact of polypills on CVD outcomes, mortality, adherence, and side effects across different settings has not previously been reported. We performed a systematic review and meta-analysis of randomized controlled trials examining the association between polypill therapy and CVD outcomes published before February 2021. The primary outcome of interest was the risk of major adverse CVD events (MACE). Risk ratios for dichotomous outcomes were converted to log RR and pooled using a generic inverse variance weighted random-effects model. Data for continuous outcomes were pooled using random-effects modeling and presented as mean differences with 95% CIs. Eight studies representing 25,584 patients were included for analysis. In the overall pooled analysis, the use of polypills was associated with a non-significant reduction in the risk of MACE (RR: 0.85; 95% CI: 0.70-1.02) and significant reductions in the risk of all-cause mortality (RR: 0.90; 95% CI: 0.81-1.00). The reductions in the risk of MACE with polypill use varied by baseline risk and nature of the study population (primary prevention vs. secondary prevention), with the most significant risk reduction among lower-risk cohorts, including within primary prevention populations [RR 0.70 (0.62, 0.79)]. Among measures of CVD risk factors, modest but significant reductions were observed for systolic and diastolic blood pressure [systolic: mean difference 1.99 mmHg (95% CI: -3.07 to -0.91); diastolic: mean difference 1.30 mmHg (95% CI: -2.42 to -0.19), but not for levels of total or low-density lipoprotein-cholesterol. Use of the polypill strategy significantly improved drug adherence (RR: 1.31; 95% CI: 1.11-1.55) with no association between polypill use and rates of adverse events or drug discontinuation. The use of polypill formulations is associated with significant reductions in CVD risk factors and the risk of all-cause mortality and MACE, particularly in the low-risk and primary prevention population. [ABSTRACT FROM AUTHOR]

OPD is the mirror of the hospital, which reflects the functioning of the hospital being the first point of contact between the patient and hospital staff. Patients visit the OPD for various purposes, like consultation, day care treatment, investigation, referral, admission and post discharge follow-up. Hence the scope of OPD services extends to not only treatment but also preventive and promotive services. However the OPDs are plagued with the problem of process delays like long waiting time. It's often one of the most frustrating part about the healthcare delivery system. Waiting time for elective care has been considered a serious problem in many healthcare systems since it acts as a barrier to efficient patient flow. This contributes to poor service delivery and a lackluster work environment. Non-value-adding activities result in, inter alia, long cycle and waiting times, and low staff morale. A study was carried out in a Tertiary Care Hospital (TCH) in Pune to study the operational efficiency of the OPD by mapping the flow process and suggest means to improve it. In order to improve operational efficiency by reducing bottlenecks in the workflow of the OPD a lean method -- Value Stream Mapping was employed. With Lean thinking, health care managers can tackle specific issues to improve operational efficiency. The entire OPD patient flow was mapped using a time motion study for a sample of 500 patients. Value Stream Mapping consisted of drawing the process flow as it was happening at present. It consisted of both Value Added & Non- Value Added activities. A Value Stream Improvement Plan was made to eliminate these bottlenecks or reduce the activities that do not add value, with reducing the delays as the Value Stream Objective. AIM: To improve the operational efficiency of the Out Patient Department using the lean method. OBJECTIVES: * To map the current OPD flow process * To identify the value adding and non-value adding activities * To study and analyze the causes for "waste" or delayed process time. * To create a value stream improvement plan to optimize the flow process. SCOPE: * The study examines the impact of Lean on operational efficiency only in the OPD; it does not extend to other departments in the hospital. * The bottlenecks leading to increased waste or delayed process time in the OPD will be identified and reduced using lean (VSM). * Streamlining the OPD flow process for maximization of efficiency will be achieved. * The applicability of Lean is determined for the duration of the study, and the effect on cycle and waiting times and staff attitudes is looked at, but the sustainability thereof is not explored. LIMITATIONS: * Patients visiting multiple doctors were excluded. [ABSTRACT FROM AUTHOR]

Background: Racial disparities in heart failure hospitalization and mortality are well established; however, the association between different social determinants of health (SDOH) and length of stay (LOS) and the extent to which this association may differ across racial groups is not well established. Methods: We utilized data from the Get With The Guidelines-Heart Failure registry to evaluate the association between SDOH, as determined by patients' residential ZIP Code and LOS among patients hospitalized with heart failure. We also assessed the race-specific contribution of the ZIP Code–level SDOH to LOS in patients of Black and non-Black races. Finally, we evaluated SDOH predictors of racial differences in LOS at the hospital level. Results: Among 301 500 patients (20.2% Black race), the median LOS was 4 days. In adjusted analysis accounting for patient-level and hospital-level factors, SDOH parameters of education, income, housing instability, and foreign-born were significantly associated with LOS after adjusting for clinical status and hospital-level factors. SDOH parameters accounted for 25.8% of the total attributable risk for prolonged LOS among Black patients compared with 10.1% in patients of non-Black race. Finally, hospitals with disproportionately longer LOS for Black versus non-Black patients were more likely to care for disadvantaged patients living in ZIP Codes with a higher percentage of foreign-born and non-English speaking areas. Conclusions: ZIP Code–level SDOH markers can identify patients at risk for prolonged LOS, and the effects of SDOH parameters are significantly greater among Black adults with heart failure as compared with non-Black adults. [ABSTRACT FROM AUTHOR]

Previous studies have shown beneficial effects of individual dietary approaches for blood pressure (BP) control, but their relative effectiveness is not well established. We performed a systematic review of published dietary pattern interventions and estimated the aggregate BP effects through meta-analysis. PubMed, EMBASE, and Web of Science databases were searched to identify studies published between January 1, 1990 and March 1, 2015. Studies meeting specific inclusion and exclusion criteria were selected. Data were pooled using random effects meta-analysis models. Twenty-four trials with 23 858 total participants were included. The overall pooled net effect of dietary intervention on systolic BP and diastolic BP was -3.07 mm Hg (95% confidence interval, -3.85 to -2.30) and -1.81 mm Hg (95% confidence interval, -2.24 to -1.38), respectively. The Dietary Approaches to Stop Hypertension diet had the largest net effect (systolic BP, -7.62 mm Hg [95% confidence interval, -9.95 to -5.29] and diastolic BP, -4.22 mm Hg [95% confidence interval, -5.87 to -2.57]). Low-sodium; low-sodium, high-potassium; low-sodium, low-calorie; and low-calorie diets also led to significant systolic and diastolic BP reductions, whereas Mediterranean diet participants experienced a significant incremental reduction in diastolic but not systolic BP. Subgroup analysis also showed important variations in effectiveness based on duration, size, and participant demographics. In conclusion, dietary modifications are associated with clinically meaningful, though variable, reductions in BP. Some diets are more effective than others and under different circumstances, which has important implications from both clinical and public health perspectives. [ABSTRACT FROM AUTHOR]

Competing Interests: Disclosures The authors have no conflicts of interest to declare.

Background: Black individuals have high incident diabetes risk, despite having paradoxically lower triglyceride and higher HDL (high-density lipoprotein) cholesterol levels. The basis of this is poorly understood. We evaluated the participants of SPRINT (Systolic Blood Pressure Intervention Trial) to assess the association of estimated European genetic ancestry with the risk of incident diabetes in self-identified Black individuals., Methods: Self-identified non-Hispanic Black SPRINT participants free of diabetes at baseline were included. Black participants were stratified into tertiles (T1-T3) of European ancestry proportions estimated using 106 biallelic ancestry informative genetic markers. The multivariable-adjusted association of European ancestry proportion with indices of baseline metabolic syndrome (ie, fasting plasma glucose, triglycerides, HDL cholesterol, body mass index, and blood pressure) was assessed. Multivariable-adjusted Cox regression determined the risk of incident diabetes (fasting plasma glucose ≥126 mg/dL or self-reported diabetes treatment) across tertiles of European ancestry proportion., Results: Among 2466 Black SPRINT participants, a higher European ancestry proportion was independently associated with higher baseline triglyceride and lower HDL cholesterol levels ( P <0.001 for both). European ancestry proportion was not associated with baseline fasting plasma glucose, body mass index, and blood pressure ( P >0.05). Compared with the first tertile, those in the second (hazard ratio, 0.64 [95% CI, 0.45-0.90]) and third tertiles (hazard ratio, 0.61 [95% CI, 0.44-0.89]) of the European ancestry proportion had a lower risk of incident diabetes. A 5% point higher European ancestry was associated with a 29% lower risk of incident diabetes (hazard ratio, 0.71 [95% CI, 0.55-0.93]). There was no evidence of a differential association between the European ancestry proportion tertiles and incident diabetes between those randomized to intensive versus standard blood pressure treatment., Conclusions: The higher risk of incident diabetes in Black individuals may have genetic determinants in addition to adverse social factors. Further research may help understand the interplay between biological and social determinants of cardiometabolic health in Black individuals. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062.

Objectives: To estimate the pooled relative risk (RR) of incident acute myocardial infarction (AMI) among HIV-infected adults compared with HIV-uninfected controls and explore the contribution of traditional and HIV-related risk factors., Background: Understanding AMI risk and associated risk factors in HIV-infected populations has the potential to inform clinical management and prevention strategies., Methods: We systematically identified cohort studies of HIV-infected or HIV-infected and matched uninfected adults reporting AMI incidence rates published up to January 1, 2017. Random-effects meta-analysis models were used to estimate the aggregate RR of AMI by HIV status. Subgroup analysis and meta-regression were used to explore factors affecting risk., Results: Sixteen studies (N = 1,619,690, median age 38.5 years, 78.9% male, mean follow-up of 6.5 years) were included. In pooled analyses of HIV-infected and matched uninfected cohorts (n = 5), HIV-infected individuals had higher AMI incidence rates (absolute risk difference = 2.2 cases per 1000 persons per year) and twice the risk of AMI [RR = 1.96 (1.5-2.6)] compared with matched HIV-uninfected controls. In a multivariate meta-regression, each additional percentage point in the proportion of male participants [odds ratio (OR) = 1.20 (1.14-1.27)] and each additional percentage point in the prevalence of hypertension [OR = 1.19 (1.12-1.27)], dyslipidemia [OR = 1.09 (1.07-1.11)], and smoking [OR = 1.09 (1.05-1.13)] were independently associated with increased AMI risk in HIV-infected adults., Conclusions and Relevance: Chronic HIV infection is associated with a 2-fold higher AMI risk. Traditional risk factors such as hypertension, dyslipidemia, and smoking are significant contributors to AMI risk among HIV-infected adults and should be aggressively targeted in routine HIV care.

Objective: To assess the effectiveness of exercise and pharmacotherapy interventions in reducing visceral adipose tissue (VAT)., Patients and Methods: A systematic search of Ovid MEDLINE, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov, New York Academy of Science Grey Literature Report, and OpenGrey was combined with hand searches of existing literature. A total of 2515 titles and abstracts were reviewed. Only randomized controlled trials evaluating the effectiveness of monitored exercise or pharmacological interventions in reducing VAT by using computed tomography or magnetic resonance imaging during a sustained intervention period (≥6 months) were included. Data were independently extracted by reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and assessed for quality and risk of bias. Separate analyses for each intervention were performed using random effect models, with pooled estimates of the change in VAT area (in centimeters squared) from baseline to follow-up reported as standardized mean difference (SMD; with 95% CI)., Results: A total of 3602 participants from 17 randomized controlled trials were included in the final analysis. Both exercise and pharmacological interventions were associated with significant reductions in VAT: small reduction with pharmacological interventions (SMD, -0.27; 95% CI, -0.47 to -0.07; P=.02) and more substantial reductions with exercise interventions (SMD, -0.54; 95% CI, -0.63 to -0.46; P<.001). The mean absolute VAT reduction was greater in pharmacological trials than in exercise trials. Meta-regression exhibited a linear correlation between VAT and weight loss (R 2 =0.52 for exercise and R 2 =0.88 for pharmacological interventions), but VAT reduction relative to weight loss differed by intervention type., Conclusion: Exercise interventions resulted in greater reduction in VAT relative to weight loss than did pharmacological interventions. A preferential reduction in VAT may be clinically meaningful when monitoring success of interventions because weight loss alone may underestimate benefits., (Copyright © 2018 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)