scholarly journals Utilizing three years of epidemiological data from medical missions in Cambodia to shape the mobile medical clinic formulary

2017 ◽  
Vol 4 (1) ◽  
pp. 13 ◽  
Author(s):  
Jeany Kim Jun ◽  
Junia S. Koo ◽  
Amy Y. Kang ◽  
Deborah B. Chien ◽  
Albert Shim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intestinal Parasites ◽  
Epidemiological Data ◽  
Gastrointestinal Disorders ◽  
Channel Blockers ◽  
Medical Clinic ◽  
Converting Enzyme Inhibitors ◽  
Medical Clinics ◽  
Common Diseases ◽  
Common Diagnosis

Objective:  The purpose of this project was to gather epidemiological data on common diseases and medications dispensed during medical mission teams to Cambodia to shape the mobile medical clinic formulary.Methods:  Data for patients seen during week-long, mobile, medical clinics was collected in Cambodia during Septembers 2012 to 2014.  Patient’s gender, age, weight, blood pressure, glucose, pertinent laboratory values, diagnoses, and medications dispensed were collected.  Blood pressure and glucose were measured in patients 18 years and above.  Data collected onto paper intake forms were transferred onto spreadsheets without patient identifying information and analyzed for aggregate means, common diseases, and most dispensed medications.  This project received institutional review board approval.Results:  A total of 1,015 patients were seen over three years.  Women made up 61.4% and the mean age was 41.8 years.   The most common diagnosis was gastrointestinal disorders  (22.9%), which included gastroesophageal reflux disease and intestinal parasites.  Next, 20.1% of patients had hypertension (BP>140/90), 18.0% had presbyopia, 15.4% had back and joint pain, followed by 8.8% with headache, including migraines.  Approximately 8.4% of patients had hyperglycemia (RPG >140 mg/dl).  Top five medications dispensed were acetaminophen, omeprazole, multivitamin, ibuprofen and metformin.   For hypertension, amlodipine and lisinopril were dispensed.Conclusion:  Cambodia lacks systematic public health collection of epidemiological data for prevalence of diseases.  Hence, investigators collected and analyzed information from week-long mobile medical clinics over three years.  Proton-pump inhibitors and H. pylori lab tests are recommended for gastrointestinal disorders.  Acetaminophen and ibuprofen are recommended for pain.  Angiotensin-converting-enzyme inhibitors and dihydropyridine calcium channel blockers are recommended over diuretics since patients are already dehydrated.  Metformin is recommended for diabetes.  Vitamins and supplements are recommended for malnourished patients.  Hemoglobin machine and urine test strips are suggested.  This information should help future teams decide what medications and laboratory tests are most beneficial on medical teams in Cambodia. 

scholarly journals Control of blood pressure and cardiovascular outcomes in type 2 diabetes

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 304-323 ◽  
Author(s):  
Hernando Vargas-Uricoechea ◽  
Manuel Felipe Cáceres-Acosta
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Events ◽  
Angiotensin Receptor Blockers ◽  
Pharmacological Therapy ◽  
Current Evidence ◽  
Diabetic Patients ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Patients With Diabetes ◽  
The Impact

AbstractHigh blood pressure in patients with diabetes mellitus results in a significant increase in the risk of cardiovascular events and mortality. The current evidence regarding the impact of intervention on blood pressure levels (in accordance with a specific threshold) is not particularly robust. Blood pressure control is more difficult to achieve in patients with diabetes than in non-diabetic patients, and requires using combination therapy in most patients. Different management guidelines recommend initiating pharmacological therapy with values >140/90 mm/Hg; however, an optimal cut point for this population has not been established. Based on the available evidence, it appears that blood pressure targets will probably have to be lower than <140/90mmHg, and that values approaching 130/80mmHg should be recommended. Initial treatment of hypertension in diabetes should include drug classes demonstrated to reduce cardiovascular events; i.e., angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, diuretics, or dihydropyridine calcium channel blockers. The start of therapy must be individualized in accordance with the patient's baseline characteristics, and factors such as associated comorbidities, race, and age, inter alia.

Associations of Blood Pressure with Functional and Cognitive Changes in Patients with Alzheimer's Disease

2016 ◽  
Vol 41 (5-6) ◽  
pp. 314-323 ◽  
Author(s):  
Fabricio Ferreira de Oliveira ◽  
Elizabeth Suchi Chen ◽  
Marilia Cardoso Smith ◽  
Paulo Henrique Ferreira Bertolucci
Keyword(s):  
Alzheimer’S Disease ◽  
Blood Pressure ◽  
Alzheimer's Disease ◽  
Rating Scale ◽  
Late Onset ◽  
Angiotensin Receptor Blockers ◽  
Channel Blockers ◽  
Clinical Dementia Rating ◽  
Cognitive Changes ◽  
Converting Enzyme Inhibitors

Background: Midlife hypertension followed by late life hypotension resulting from neurodegeneration increases amyloidogenesis and tauopathy. Methods: Consecutive outpatients with late-onset Alzheimer's disease (AD) at various stages and their respective caregivers were assessed for score variations in 1 year of tests assessing caregiver burden, functionality and cognition according to blood pressure (BP) variations and APOE haplotypes, while also taking into account differential effects of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, calcium channel blockers, diuretics, or no antihypertensive medication on score changes. The diagnosis and treatment of arterial hypertension followed the JNC 7 report. Results: Variations in systolic BP (-11.76 ± 17.1 mm Hg), diastolic BP (-4.92 ± 10.3 mm Hg) and pulse pressure (-6.84 ± 12.6 mm Hg) were significant after 1 year (n = 191; ρ < 0.01). For APOE4+ carriers, rises in systolic or diastolic BP improved Clinical Dementia Rating Scale Sum of Boxes scores (ρ < 0.04), with marginally significant improvements in Mini-Mental State Examination scores resulting from risen systolic (ρ = 0.069) or diastolic BP (ρ = 0.079), and in basic independence only regarding risen diastolic BP (ρ = 0.055). APOE4- carriers resisted any functional or cognitive effects of BP variations. No differences were found regarding any antihypertensive class for variations in BP or any test scores, regardless of APOE haplotypes. Conclusions: Targeting mild BP elevations brings better functional and cognitive results for APOE4+ carriers with AD.

Sex differences in antihypertensive drug use and blood pressure control

2019 ◽  
Vol 95 (1124) ◽  
pp. 295-299
Author(s):  
Junwen Wang ◽  
Weihong Jiang ◽  
Manju Sharma ◽  
Yuyan Wu ◽  
Jiayin Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sex Differences ◽  
Drug Use ◽  
Antihypertensive Drug ◽  
Antihypertensive Drugs ◽  
Age Groups ◽  
Channel Blockers ◽  
Elderly Age ◽  
Converting Enzyme Inhibitors ◽  
Males And Females

BackgroundHypertension is the most important modifiable cardiovascular risk factor. Epidemiological studies have shown the benefits of lowering blood pressure (BP), but BP control is a major challenge. Furthermore, there are significant sex differences in antihypertensive drug use and BP control. This study examined sex differences in antihypertensive drug use and BP control, with the aim of reducing the complications of hypertension and improving quality of life.MethodsThe study was performed in our outpatient hypertension clinic, and included 1529 patients without secondary hypertension or comorbidities. The study, investigated BP control rates and patterns of antihypertensive drug use in male and female. All data were collected using structured questionnaires and patient measurements.ResultsThe study included 713 males and 816 females in this study. Fewer females had hypertension in the younger age group (16.2% vs 11.6%; p>0.05), but this difference disappeared in middle-aged (47.8% vs 49.9 %; p<0.05) and elderly age groups (36.0% vs 38.5%; p<0.05). BP control rates differed between males and females (35.6% in male, 31.9% in female, p<0.01). There was an overall difference in BP control rates between males and females (35.6% in males, 31.9% in females, p<0.01). In this aged 18–44 years, angiotensin converting enzyme inhibitors (ACEIs) showed the best control rate in males, while calcium channel blockers (CCBs) were least effective (61.5% with ACEIs, 28.6% with CCBs; p<0.05). In this aged 45–64 years, diuretics (DUs) showed the best control rate in females, while CCBs were least effective (47.5% with DUs, 28.3% with CCBs; p<0.05).ConclusionsSex plays an important role in BP control. In those aged 18–44 years, males using ACEIs showed best control rates. In those aged 45–64 years, females using DUs showed best control rates. Our study provides a basis with the selection of antihypertensive drugs according to sex and age.

Arterial stiffness: from isolated systolic hypertension to syncope

ESC CardioMed ◽  
2018 ◽  
pp. 2971-2976
Author(s):  
Jerzy Gąsowski ◽  
Chirag Bavishi ◽  
Franz H Messerli
Keyword(s):  
Blood Pressure ◽  
Pulse Pressure ◽  
Systolic Hypertension ◽  
Pulse Wave ◽  
Angiotensin Receptor Blockers ◽  
The Elderly ◽  
Channel Blockers ◽  
Isolated Systolic Hypertension ◽  
Converting Enzyme Inhibitors ◽  
European Guidelines

Isolated systolic hypertension (ISH) is the predominant form of hypertension in the elderly. The pathophysiology includes a plethora of factors; however, the stiffening of large arteries, leading to wider pulse pressure and faster propagation of the pressure pulse wave, are at the core of the disease. It has been shown that higher systolic blood pressure (SBP), pulse pressure, and pulse wave velocity are associated with a greater risk of cardiovascular complications, including a greater risk of dementia. In elderly patients, the relationship between SBP and the risk of mortality starts increasing at about 160 mmHg. A number of clinical trials were performed in populations of patients which included the elderly, however only four trials were specifically dedicated to answer the question of whether the active treatment of ISH (SHEP, Syst-Eur, Syst-China) or treatment of octogenarian hypertensive patients (HYVET) lowers cardiovascular risk in the elderly patient. They all showed that regimens based on thiazide-like diuretics, dihydropyridine calcium channel blockers, or angiotensin-converting enzyme inhibitors are capable of reducing the risk along with the appropriate reduction of SBP. This is widely reflected in the current European guidelines, with the addition of angiotensin receptor blockers. Nevertheless, the debate on the appropriate blood pressure goal is ongoing. However, none of the trials in the elderly had an average SBP lowered to less than 140 mmHg, and the overwhelming evidence suggests that in patients above the age of 70 with overt cardiovascular disease, a SBP less than 130 mmHg may be associated with an increase in risk.

Use of Antihypertensive and Antithrombotic Medications after Stroke in Community-Based Care

2001 ◽  
Vol 35 (7-8) ◽  
pp. 811-816 ◽  
Author(s):  
Sally K Rigler ◽  
Melissa J Webb ◽  
Atul T Patel ◽  
Sue Min Lai ◽  
Pamela W Duncan
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Antihypertensive Medication ◽  
Medication Use ◽  
Antihypertensive Agents ◽  
Channel Blockers ◽  
Community Based ◽  
Converting Enzyme Inhibitors ◽  
Stroke Study ◽  
Blood Pressures

BACKGROUND: Secondary stroke prevention strategies include pharmacologic approaches to control hypertension and reduce thromboembolic risk. OBJECTIVE: To describe antithrombotic and antihypertensive medication use, and rates of blood pressure control in the Kansas City Stroke Study, a prospective stroke cohort receiving community-based care after primarily mild and moderate stroke. METHODS: Participants from 12 area hospitals provided information about medication use prior to stroke. Study personnel measured blood pressures at enrollment and at one, three, and six months, and collected medication data at six months during in-home assessment. RESULTS: Complete data at six months were available for 355 subjects with ischemic stroke, among whom 13% had atrial fibrillation and 67% had prior hypertension. Prior to stroke, only 45% of the patients were receiving any antithrombotic (anticoagulant and/or antiplatelet) therapy; this figure rose to 77% at six months. Antithrombotic treatment rates among those with atrial fibrillation were 59% before stroke and 83% at six months, including warfarin in 64%. Approximately 70% of subjects had controlled blood pressures one, three, and six months after stroke, defined as systolic blood pressure ≤140 mm Hg and diastolic blood pressure ≤90 mm Hg. Use of multiple antihypertensive agents was common; calcium-channel blockers and angiotensin-converting enzyme inhibitors were used most frequently. However, 19% of subjects with uncontrolled blood pressure were untreated at six months. CONCLUSIONS: Although room for improvement remains, these data suggest improved rates of antithrombotic and antihypertensive medication use after stroke in community-based care in a midwestern metropolitan community, compared with previous reports.

Abstract 007: Comparative Effectiveness of Blood Pressure Lowering Drugs in Reducing Cardiovascular Events: Results From a Network Meta-Analysis

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Jingkai Wei ◽  
Karla I Galaviz ◽  
Alysse Kowalski ◽  
Matthew J Magee ◽  
J. Sonya Haw ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Angiotensin Converting Enzyme ◽  
Cardiovascular Events ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Cardiovascular Death ◽  
Channel Blockers ◽  
Blood Pressure Lowering ◽  
Converting Enzyme Inhibitors ◽  
Drug Classes ◽  
Pressure Lowering

Introduction: Blood pressure lowering drugs help prevent cardiovascular events though less is known about the comparative effectiveness of different drug classes. We aimed to compare the effect of different blood pressure lowering drugs classes on cardiovascular risk. Hypothesis: We hypothesized that the cardiovascular preventive effects of blood pressure lowering drugs would vary among different types of drug classes. Methods: PubMed, EMBASE, and Cochrane Library databases were searched for articles published between January 1, 1990 and June 30, 2014. Study eligibility criteria included randomized controlled trials testing blood pressure-lowering drugs, including angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers, calcium-channel blockers, beta-blockers, and thiazide diuretics that reported cardiovascular outcomes (cardiovascular death, myocardial infarction, stroke, coronary revascularization and composite cardiovascular events) with at least 6 months of follow-up. Data from studies that met inclusion criteria were independently extracted by two reviewers using a standardized extraction form. For each outcome, a Frequentist, random effects network meta-analysis model was used to compare risk reductions between drug classes. The relative ranking probability of each blood pressure lowering drug class being the most effective was estimated using rankogram curves, surface under the cumulative ranking curves, and mean ranks. Results: A total of 102 trials that included 415,047 participants (mean age 65.1 years, 60.0% male) met inclusion criteria. Compared to placebo, blood pressure lowering drugs reduced the risk of composite cardiovascular events by 11-18% in aggregate. Calcium channel blockers were the most effective in reducing composite cardiovascular events risk (RR=0.82, 95% CI: 0.77, 0.88), stroke (RR=0.68, 95% CI: 0.61, 0.75) and revascularization (RR=0.84, 95% CI: 0.77, 0.92); angiotensin-converting-enzyme inhibitors were the most effective in reducing cardiovascular death (RR=0.85, 95% CI: 0.80, 0.91) and myocardial infarction (RR=0.83, 95% CI: 0.77, 0.91). Effects of drugs were influenced by blood pressure, where each 10mmHg reduction in systolic and diastolic blood pressure, regardless of drug class, was associated with a 2.5% (95% CI: -3.8, -1.2) and 5.4% (95% CI: -8.0, -2.4) lower risk of composite cardiovascular events, respectively. Conclusion: Angiotensin-converting-enzyme inhibitors had an advantage over other blood pressure lowering drugs in preventing myocardial infarction and cardiovascular death, while calcium channel blockers were more effective in preventing overall cardiovascular events, stroke and revascularization. Future studies should compare the effectiveness of combination of drug classes in reducing cardiovascular events.

scholarly journals Oral drugs for hypertensive urgencies: systematic review and meta-analysis

2009 ◽  
Vol 127 (6) ◽  
pp. 366-372 ◽  
Author(s):  
Luciana Mendes Souza ◽  
Rachel Riera ◽  
Humberto Saconato ◽  
Adriana Demathé ◽  
Álvaro Nagib Atallah
Keyword(s):  
Blood Pressure ◽  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibitors ◽  
Target Organ Damage ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Organ Damage ◽  
Channel Blockers ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibitors ◽  
Hypertensive Urgencies

CONTEXT AND OBJECTIVE: Hypertensive urgencies are defined as severe elevations in blood pressure without evidence of acute or progressive target-organ damage. The need for treatment is considered urgent but allows for slow control using oral or sublingual drugs. If the increase in blood pressure is not associated with risk to life or acute target-organ damage, blood pressure control must be implemented slowly over 24 hours. For hypertensive urgencies, it is not known which class of antihypertensive drug provides the best results and there is controversy regarding when to use antihypertensive drugs and which ones to use in these situations. The aim of this review was to assess the effectiveness and safety of oral drugs for hypertensive urgencies. METHODS: This systematic review of the literature was developed at the Brazilian Cochrane Center, and in the Discipline of Emergency Medicine and Evidence-Based Medicine at the Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp-EPM), in accordance with the methodology of the Cochrane Collaboration. RESULTS: Sixteen randomized clinical trials including 769 participants were selected. They showed that angiotensin-converting enzyme inhibitors had a superior effect in treating hypertensive urgencies, evaluated among 223 participants. The commonest adverse event for calcium channel blockers were headache (35/206), flushing (17/172) and palpitations (14/189). For angiotensin-converting enzyme inhibitors, the principal side effect was bad taste (25/38). CONCLUSIONS: There is important evidence in favor of the use of angiotensin-converting enzyme inhibitors for treating hypertensive urgencies, compared with calcium channel blockers, considering the better effectiveness and the lower frequency of adverse effects (like headache and flushing).

Dispensing Patterns of Blood Pressure Lowering Agents in Older Australians From 2006 to 2016

2018 ◽  
Vol 24 (3) ◽  
pp. 242-250 ◽  
Author(s):  
Si Si ◽  
Richard Ofori-Asenso ◽  
Tom Briffa ◽  
Jenni Ilomaki ◽  
Frank Sanfilippo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Anatomical Therapeutic Chemical ◽  
Temporal Trends ◽  
World Health ◽  
Fixed Dose ◽  
Channel Blockers ◽  
Blood Pressure Lowering ◽  
Converting Enzyme Inhibitors ◽  
Pressure Lowering ◽  
Over Time

Background: Increasing numbers of blood pressure lowering (BPL) agents are being prescribed for both primary and secondary prevention of cardiovascular disease, especially in the older population. The aim of this study is to describe the temporal trends and patterns of BPL dispensing among older Australians (aged ≥65 years). Methods: We utilized prescription claims data from the Australian Pharmaceutical Benefits Scheme (PBS) for a 10% random sample of people aged ≥65 years. The PBS, funded by the Federal government, provides subsidies to make medicines more affordable for Australian residents. We restricted our analysis to “long-term concession” individuals, who would use PBS for the majority of their medication needs. BPL agents were identified using the World Health Organization Anatomical Therapeutic Chemical classification codes. The annual prevalences and proportional distributions of BPL dispensing by categories were summarized from 2006 to 2016. Direct standardization was applied to indicate changes of BPL dispensing over time. Results: Age-standardized dispensing of BPL agents increased by 8% among older Australians from 2006 to 2016 (58%-66%). BPL dispensing in males has exceeded that in females since 2009. Angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers were the dominant BPL agents dispensed, with more than 55% of all BPL users over time. Dispensing of diuretics decreased from 27% to 21%, calcium channel blockers decreased from 30% to 25%, while β-blockers remained stable (29%-31%). The use of fixed-dose combinations increased over time from 23% to 31%. Conclusion: The prevalence of BPL dispensing steadily increased among older Australians from 2006 to 2016. The changes in the patterns of BPL dispensing were largely in line with contemporary changes to clinical guidelines for an aging population.

scholarly journals Pattern of Medication Prescribing and Factors Associated with Meeting of Target Blood Pressure among Persons with Hypertension in Federal Police Referral Hospital, Ethiopia

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Tariku Shimels
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Agents ◽  
Structured Interview ◽  
Referral Hospital ◽  
Channel Blockers ◽  
Antihypertensive Medications ◽  
Converting Enzyme Inhibitors ◽  
Cross Sectional ◽  
Factors Associated ◽  
Study Participants

Introduction: Hypertension is one of the highly growing chronic health challenges worldwide causing a significant number of deaths and cardiovascular complications. The prevalence of the condition in Ethiopia was estimated to be 19.5% with an urban and rural subgroup proportion of 25.7% and 14.7% respectively. This study was conducted to assess the pattern of prescribing antihypertensive medications and factors associated with BP target meeting among persons with hypertension in Federal Police Referral Hospital. Method: An institution based cross sectional study was conducted from 15th October 2016 to 15th January 2017. A systematic random sampling technique was employed in selecting the study participants. Data was collected using a semi-structured interview of study participants and visiting medication records. SPSS version 20 was used for data entry and analysis. Results: Of the 330 subjects required to be included in the study, 318 (96.4%) fulfilled the inclusion criteria and were considered for further analysis. Diuretics were the top prescribed class of antihypertensive agents accounted by 201(63.2%) of the subjects. Hydrochlorothiazide, a thiazide diuretic, was the most frequent. Next highly utilized classes of drugs included; calcium channel blockers among 172 (54.1%) subjects followed by angiotensin converting enzyme inhibitors prescribed for 153 (48.1%) participants. Target meeting for the systolic and diastolic blood pressure accounted for 142 (44.7%) and 140(44%) of the study subjects respectively. Overall target meeting of the two variables was attained by 103(32.4%) of the participants. Conclusion: Diuretics were the class of drugs most frequently prescribed succeeded by CCBs and ACEIs. The result of this study has also shown that overall BP target meeting among the subjects was suboptimal. Multivariate binary logistic regression has shown that gender, duration of therapy and dietary adherence were associated with BP target meeting.

The impact of medical interventions on admission characteristics in children with congenital heart disease and cardiomyopathy

2020 ◽  
pp. 1-8
Author(s):  
Rohit S. Loomba ◽  
Jacqueline Rausa ◽  
Vincent Dorsey ◽  
Ronald A. Bronicki ◽  
Enrique G. Villarreal ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Length Of Stay ◽  
Congenital Heart ◽  
Unit Length ◽  
Channel Blockers ◽  
Regression Analyses ◽  
Converting Enzyme Inhibitors ◽  
Medical Interventions ◽  
The Impact

Abstract Introduction: Children with congenital heart disease and cardiomyopathy are a unique patient population. Different therapies continue to be introduced with large practice variability and questionable outcomes. The purpose of this study is to determine the impact of various medications on intensive care unit length of stay, total length of stay, billed charges, and mortality for admissions with congenital heart disease and cardiomyopathy. Materials and methods: We identified admissions of paediatric patients with cardiomyopathy using the Pediatric Health Information System database. The admissions were then separated into two groups: those with and without inpatient mortality. Univariate analyses were conducted between the groups and the significant variables were entered as independent variables into the regression analyses. Results: A total of 10,376 admissions were included these analyses. Of these, 904 (8.7%) experienced mortality. Comparing patients who experienced mortality with those who did not, there was increased rate of acute kidney injury with an odds ratio (OR) of 5.0 [95% confidence interval (CI) 4.3 to 5.8, p < 0.01], cardiac arrest with an OR 7.5 (95% CI 6.3 to 9.0, p < 0.01), and heart transplant with an OR 0.3 (95% CI 0.2 to 0.4, p < 0.01). The medical interventions with benefit for all endpoints after multivariate regression analyses in this cohort are methylprednisolone, captopril, enalapril, furosemide, and amlodipine. Conclusions: Diuretics, steroids, angiotensin-converting enzyme inhibitors, calcium channel blockers, and beta blockers all appear to offer beneficial effects in paediatric cardiomyopathy admission outcomes. Specific agents within each group have varying effects.

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