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      Prescribing patterns of coronary artery aneurysm in Taiwan

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          Abstract

          Background

          Coronary artery aneurysm (CAA) is a rare disease, and there are limited data on prescribing patterns for CAA. The aim of our study was to investigate prescribing patterns for CAA in Taiwan via the National Health Insurance Research Database (NHIRD).

          Methods

          We included all CAA patients in Taiwan from 2005 to 2011. Data from 1 year before and after the CAA diagnosis were used to analyze examinations, comorbidities and prescribing patterns.

          Results

          A total of 1397 patients diagnosed with CAA were enrolled in our study. Most pediatric patients with CAA were diagnosed with Kawasaki disease (95.7%). In pediatric CAA patients, the utilization rates of aspirin and gamma globulins were 82.9 and 53.6%, respectively, after CAA diagnosis. Among the antithrombotic agents, aspirin was used most commonly, followed by dipyridamole (16.9%), heparin (5.8%) and warfarin (4.6%). In adult CAA patients, common comorbidities included hypertension (63.4%), hyperlipidemia (39.6%), and diabetes mellitus (26.1%). Coronary atherosclerosis was identified in 72.5% of adult patients after CAA diagnosis. Antithrombotic agents, particularly aspirin, clopidogrel and heparin, were prescribed more frequently after CAA diagnosis. Among the prescribed medications, aspirin (75.8%), β-blockers (48.3%), statins (47.6%), metformin (14.4%), sulfonylureas (14.4%) and isosorbide mononitrate (32.9%) were frequently observed in each category.

          Conclusions

          Kawasaki disease was the main cause of CAA in pediatric patients, and coronary artery disease was the most common comorbidity in adult CAA patients. The most commonly used antithrombic agent after CAA diagnosis was aspirin in both adult and pediatric patients.

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          Most cited references31

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          Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association

          Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in approximately 15% to 25% of untreated children and may lead to ischemic heart disease or sudden death. A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for > or =5 days and < or =4 classic criteria should undergo echocardiography, receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-alpha antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata. Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients.
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            Diagnosis and therapy of Kawasaki disease in children.

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              Coronary Artery Aneurysms in Kawasaki Disease: Risk Factors for Progressive Disease and Adverse Cardiac Events in the US Population

              Background The natural history of coronary artery aneurysms (CAA) after intravenous immunoglobulin (IVIG) treatment in the United States is not well described. We describe the natural history of CAA in US Kawasaki disease (KD) patients and identify factors associated with major adverse cardiac events (MACE) and CAA regression. Methods and Results We evaluated all KD patients with CAA at 2 centers from 1979 to 2014. Factors associated with CAA regression, maximum CA z‐score over time (zMax), and MACE were analyzed. We performed a matched analysis of treatment effect on likelihood of CAA regression. Of 2860 KD patients, 500 (17%) had CAA, including 90 with CAA z‐score >10. Most (91%) received IVIG within 10 days of illness, 32% received >1 IVIG, and 27% received adjunctive anti‐inflammatory medications. CAA regression occurred in 75%. Lack of CAA regression and higher CAA zMax were associated with earlier era, larger CAA z‐score at diagnosis, and bilateral CAA in univariate and multivariable analyses. MACE occurred in 24 (5%) patients and was associated with higher CAA z‐score at diagnosis and lack of IVIG treatment. In a subset of patients (n=132) matched by age at KD and baseline CAA z‐score, those receiving IVIG plus adjunctive medication had a CAA regression rate of 91% compared with 68% for the 3 other groups (IVIG alone, IVIG ≥2 doses, or IVIG ≥2 doses plus adjunctive medication). Conclusions CAA regression occurred in 75% of patients. CAA z‐score at diagnosis was highly predictive of outcomes, which may be improved by early IVIG treatment and adjunctive therapies.
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                Author and article information

                Contributors
                lue0203@yahoo.com.tw
                u101530009@gap.kmu.edu.tw
                haoming.chen1988@gmail.com
                ypfang@kmu.edu.tw
                bj003102@gmail.com
                yabihu@kmu.edu.tw
                886-7-3121101 , jk2975525@hotmail.com
                abc8870@yahoo.com.tw
                syeh@faculty.nsysu.edu.tw
                Journal
                BMC Cardiovasc Disord
                BMC Cardiovasc Disord
                BMC Cardiovascular Disorders
                BioMed Central (London )
                1471-2261
                5 August 2019
                5 August 2019
                2019
                : 19
                : 188
                Affiliations
                [1 ]Division of Pharmacy, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
                [2 ]Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan
                [3 ]ISNI 0000 0000 9476 5696, GRID grid.412019.f, School of Pharmacy, , Kaohsiung Medical University, ; 100, Shiquan 1st Rd., Sanmin Dist.,, Kaohsiung City, 80708 Taiwan, Republic of China
                [4 ]ISNI 0000 0004 0620 9374, GRID grid.412027.2, Department of Pharmacy, , Kaohsiung Medical University Hospital, ; Kaohsiung, Taiwan
                [5 ]ISNI 0000 0004 0620 9374, GRID grid.412027.2, Department of Medical Research, , Kaohsiung Medical University Hospital, ; Kaohsiung, Taiwan
                [6 ]ISNI 0000 0004 0572 9255, GRID grid.413876.f, Department of Internal Medicine, , Chi Mei Medical Center, Chiali, ; No.606, Jialixing, Jiali Dist., Tainan City, 72263 Taiwan, Republic of China
                [7 ]ISNI 0000 0004 0531 9758, GRID grid.412036.2, Department of Business Management, , National Sun Yat-sen University, ; Kaohsiung, Taiwan
                Author information
                http://orcid.org/0000-0003-4364-8248
                Article
                1172
                10.1186/s12872-019-1172-6
                6683534
                31382884
                f0613907-80b4-49ac-ba45-6404427b3055
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 2 May 2019
                : 26 July 2019
                Funding
                Funded by: Kaohsiung Medical University Hospital.
                Award ID: KMUH105-M512
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Cardiovascular Medicine
                comorbidities,coronary artery aneurysm,prescribing pattern
                Cardiovascular Medicine
                comorbidities, coronary artery aneurysm, prescribing pattern

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