POTENTIAL ROLE OF ACINULL-P IN MANAGEMENT OF AJIRNA W.S.R TO INDIGESTION

Ayurveda is the old traditional science deals with the management and prevention of diseases. Most of the diseases arise due to hypo functioning of Agni (bio-digestive power) and it is the root cause for the devel-opment of many diseases. Ayu (long life), Bala (strength) and Varna (complexion) etc. dependent on status of Agni. Agni present in the Jathara (Stomach and Intestine) which digest and metabolize the food and as-sist in growth of body hence it is termed as BhagawanIshvara- almighty God- himself. All the diseases arise as a result of less, excessive and irregular digestion of food known as Mandagni, Tikshnagni or Vi-shamagni respectively. Agni may get disturbed by erratic lifestyle and abnormal dietetic regimen. Disturbed functions of Agni cause indigestion of food is termed as Ajirna (indigestion). Ajirna is the most important source of production of Ama and favors genesis diseases. Avoidance of the etiological factor is the initial action in the management. Inappropriate lifestyle, unreliable seasonal regimen adherence, mental disturb-ance and stress may contribution in the progress of Ajirna condition. So, the Deepan, Pachan, Laghan are the basic management in Ajirna along with internal Medicine. Acinull-P which contain Trikatu, Ajmoda, Chitrakadimoola chhal, Nausadara, Swetajeeraka, Chhoti Harad, Krishna jeeraka, works on Ajirna.

Abstract 15477: Association With Post Discharge Adherence to Guideline Directed Medical Therapy and Long Term Health Outcome

Introduction: Statin, beta-blocker and Angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers have been advocated by guideline as secondary prevention medications to improve long term outcome post myocardial infarction for years. However, in reality, adherence to these medications have always been challenging and different treatment regimen adherence might lead to divergent outcomes which remains unclear in current AMI standard care. Hypothesis: To investigate the association between different guideline-directed medication regimen adherence post myocardial infarction and long-term outcomes. Methods: This cohort study used data files from Taiwan National Health Insurance Research Database (NHIRD). A total of 77520 survivors of hospitalization with AMI between 2002 and 2015 were assessed. Base on adherence to individual medications, eight treatment groups were estimated in this study. We investigate the association of adherence to different treatment groups and all-cause mortality in 24 months. Results: 51322 STEMI patients and 26198 NSTEMI patients were included in the study. All treatment groups had significant higher mortality compare with patients who adhered to all 3 medications in 24 months follow-up. Patients not adherence to any medications had the highest mortality in 24 months (adjusted HR: 1.78; 95% CI: 1.64 to 1.93). Conclusions: In this large population base real-world data study, we found that adherence to all 3 secondary prevention medications in post myocardial infarction survivor was associated lower rate of all cause mortality.

Real-world adherence to non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation measured by an electronic medication event monitoring system

Background Non-vitamin K antagonist oral anticoagulants (NOACs) are recommended as first choice therapy for thrombo-embolic prevention in patients with non-valvular atrial fibrillation (AF) and an elevated CHA2DS2-VASc score. A critical determinant for both safety and effectiveness of NOAC treatment is adherence to the prescribed medication regimen. Real-life adherence is suboptimal for many cardiovascular drugs. Measuring and improving NOAC adherence is primordial for optimising AF care. Purpose We measured adherence to any of the four NOACs in a population of AF patients who participate to a clinical trial during which they received targeted education on AF and its treatment. Methods This analysis is part of a prospective, multicenter, randomized controlled trial which is currently ongoing at three Belgian hospitals (AF-EduCare study). Ambulatory or hospitalised AF patients of that trial, treated with a NOAC, and who received a short targeted education session about AF and NOAC therapy at initiation, form the study group of this analysis. Monitoring of NOAC intake was performed by an electronic Medication Event Monitoring System (MEMS), starting immediately after initiation of the study and the education session (for 3 months). A special cap fits on a medication bottle and records the exact date and time of bottle openings. An LCD screen on the cap displays the number of openings of the medication bottle over a period of 24 hours, providing feedback about the correct intake. Dabigatran was replaced by a proxy medication as Dabigatran should be stored in the original package in order to protect it from moisture. Regimen adherence was calculated as the number of days on which one bottle opening in case of Rivaroxaban or Edoxaban and two bottle openings in case of Apixaban or Dabigatran is/are registered, divided by the total number of monitored days and multiplied by 100. Results A total of 233 patients (mean age 71.0±7.7 years; 71.2% males; CHA2DS2-VASc score 3.4±1.5; mean duration of AF history 5.8±7.5 years) were given a MEMS. Of these patients 32.2%, 31.3%, 26.2% and 10.3% were respectively on Edoxaban, Apixaban, Rivaroxaban and Dabigatran. Regimen adherence for these NOACs was 95.9±9.3%, 91.6±13.7%, 95.6±5.6% and 94.0±7.1% respectively. Overall, 94.4% of the patients had an adherence >80% and 81.1% had an adherence >90%. Adherence for the once and twice daily regimens was 95.8±0.7% and 92.2±1.3%, respectively (p=0.0003; Mann-Whitney U test). Conclusions This is a first prospective study investigating adherence for all NOACs using electronic monitoring. In this sample of AF patients who underwent a targeted education session before the 3 month monitoring period, mean adherence to NOAC intake was >90% for all NOACS. This high adherence may be related to both the education and the use of MEMS, which provided direct feedback to the patient. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The AF-EduCare study is a project supported by the Fund for Scientific Research, Flanders (T002917N).

Perspectives of Patients on Outpatient Parenteral Antimicrobial Therapy: Experiences and Adherence

Background Nonadherence to medication is a burden to the US health care system and is associated with poor clinical outcomes. Data on outpatient parenteral antimicrobial therapy (OPAT) treatment plan adherence are lacking. The purpose of this study is to determine the rate of nonadherence and factors associated with it. Methods We surveyed patients discharged from a tertiary hospital on OPAT between February and August 2019 about their baseline characteristics, OPAT regimen, adherence, and experience with OPAT. Results Sixty-five patients responded to the survey. The median age was 62 years, and 56% were male. The rate of reported nonadherence to intravenous (IV) antibiotics was 10%. Factors associated with nonadherence to IV antibiotics included younger age, household income of <$20 000, and lack of time for administering IV antibiotics (30 vs 64 years, P < .01; 83% vs 20%, P < .01, and 33% vs 4%, P = .04, in the nonadherent vs adherent groups, respectively), while less frequent administration (once or twice daily) and having friend or family support during IV antibiotic administration were associated with better adherence (17% vs 76%, P < .01, and 17% vs 66%, P = .03, in the nonadherent vs adherent groups, respectively). Most patients attended their infectious diseases clinic visits (n = 44, 71%), and the most commonly cited reasons for missing an appointment were lacking transportation (n = 12, 60%), not feeling well (n = 8, 40%), and being unaware of the appointment (n = 6, 30%). Conclusions Less frequent antibiotic dosing and better social support were associated with improved adherence to OPAT. In contrast, younger age, lower income, and lack of time were associated with nonadherence.