Saudi Cultural Missions Theses & Dissertations
Permanent URI for this communityhttps://drepo.sdl.edu.sa/handle/20.500.14154/10
Browse
2 results
Search Results
Item Restricted The Impact of Cardiac Rehabilitation on Cardiovascular function Outcomes: Potential Role of Racial Disparities(University of Illinois at Chicago, 2024-08-04) Alshammari, Saleh; Phillips, ShaneBackground: Cardiovascular disease (CVD) is a leading cause of death globally. Cardiac rehabilitation (CR) is an effective treatment for CVD. Minority groups, especially African Americans (AAs), are more vulnerable to CVD. However, the impact of CR on cardiac and vascular function outcomes and the influence of race are not yet clear. Aims: To investigate (1) the impact of CR on cardiac and vascular function, (2) the role of race in influencing improvements in cardiac and vascular function, and (3) the role of cardiac and vascular functions in predicting exercise capacity using the six-minute walk test (6MWT). Methods: We recruited 17 participants (non-AA n = 9, AA n = 8) and measured cardiac and vascular outcomes at baseline, week 4, and post-CR. Cardiac systolic functions (stroke volume [SV], cardiac output [CO], ejection fraction [EF]) and diastolic function (E/A ratio) were assessed. Vascular function was evaluated using brachial artery flow-mediated dilation (FMD) and carotid-femoral pulse wave velocity (cf-PWV). Regression analysis was utilized to predict 6MWT from cardiovascular outcomes. Results: CR improved cardiac systolic function, with SV increasing from 79.90±6.41 at baseline to 88.66±5.11 post-CR (p = 0.05), CO from 5.120±0.30 to 5.891±0.29 (p = 0.03), and EF from 40.50±1.93 to 44.30±1.67 (p = 0.01). Diastolic function (Mitral E/A) showed no significant change, but AA participants consistently had lower Mitral E/A ratios compared to non-AA participants at baseline (0.961±0.014 vs. 1.030±0.014, p = 0.002), week 4 (0.976±0.016 vs. 1.046±0.015, p = 0.004), and post-CR (0.957±0.018 vs. 1.034±0.015, p = 0.005). CR significantly improved brachial artery FMD from 2.933±0.32 to 3.969±0.28 (p = 0.02) but had no significant effect on cf-PWV (baseline: 11.716±0.59; post-CR: 10.921±0.53, p = 0.33). AA participants had consistently higher central systolic blood pressure (cSBP) and cf-PWV at all time points. Regression analysis indicated that cardiac diastolic function (Mitral E/A ratio) and arterial stiffness (cf-PWV) were significant predictors of 6MWT (R² = 0.30, p = 0.003). Conclusion: CR significantly improved cardiac systolic function and peripheral vascular function (brachial artery FMD), but had limited impact on diastolic function and central vascular function (cf-PWV). Diastolic function and arterial stiffness significantly predicted 6MWT performance. Racial differences in response to CR were evident, with AA participants showing lower improvements compared to non-AA participants.22 0Item Restricted Multimorbidity and Polypharmacy: A Health Informatics Approach(Saudi Digital Library, 2023) Aldhobaie, Ghadah; Pirmohamed, Munir; Coenen, Frans; Walker, LaurenIntroduction: Multimorbidity is increasing in prevalence, and is more common in older age groups. All bodily systems can be affected by multimorbidity (or multiple long-term conditions), and this is associated with increased healthcare utilisation and increased mortality. Additionally, people living with multiple long-term conditions are often on many drugs, which has been termed polypharmacy. This puts them at risk of adverse drug reactions, drug-drug interactions and poor adherence, all of which can increase healthcare costs. In this thesis, I have focused on cardiovascular and gastrointestinal drugs in order to understand the changes which have occurred in the usage of these drugs over the last two decades. Objective: The thesis aims to describe the changing patterns of medication prescription practice over the last two decades in older people with cardiovascular and/or gastrointestinal diseases using the Clinical Practice Research Datalink (CPRD). Methods: We extracted one million patient records from CPRD. Among these patients, we have included cardiovascular (CV) and gastrointestinal (GI) patients with two or more years of follow-up. These patients were then filtered further based on the second chronic condition and the patient’s age (whether they were 50 years and above). After adjusting for the range between the years 2001 and 2020, the number of eligible patients for this study was reduced further (used for the first group analysis). An association rule mining was applied to investigate the prescription pattern between 2001 and 2020. When this is filtered to those who had 20 years of follow-up appointments, it reduced the number and was analysed accordingly for the second group analysis to examine the change in the prescription patterns by applying specifically the Apriori algorithm Association Rules Mining. Results: For the first analysis, the extracted eligible CV and GI patients were 228,376 and 111,355, respectively. The eligible patients for the second analysis with continuous and constant 20 years follow-up were 17,075 and 3,110, respectively. In cardiovascular disease, the most commonly prescribed drug classes were statins followed by calcium channel blockers. The study also showed that there was a statistically significant increase (P-value <0.0001) in the mean number of total cardiovascular drugs prescribed in 2020 in comparison to 2001 (mean 2.201-1.581, standard deviation 1.153-0.860 respectively). In gastrointestinal disease, the most commonly prescribed drug classes were proton pump inhibitors followed by corticosteroids. In the same study period, there was a statistically significant increase (P-value <0.0001) in the mean number of total gastrointestinal drugs prescribed (mean 1.284-1.152, standard deviation 0.586-0.424 respectively). Evaluation of the 20 year follow-up data allowed association rule mining to be applied and the top 10 rules were identified. Conclusions: There was a statistically significant difference in prescription patterns during the study period. In particular, the total number of drugs increased significantly in 2020 when compared to 2001. A limitation of the studies is that only drugs associated with CV and GI diseases were evaluated, and further studies on all systems are needed. Researchers and clinicians need to better understand drug prescribing patterns overall in patients with multiple long-term conditions to develop strategies to overcome the possible adverse consequences of polypharmacy.30 0