Biomedical subjects
Cindy Thomas
Publications and source records attributed to Cindy Thomas.
Naltrexone and pharmacy benefit management.
Naltrexone was approved by the FDA in 1994 for the treatment of alcohol dependence. Despite the potential to make treatment more effective and accessible, naltrexone use remains low by almost any measure. While many of the factors responsible for the slow pace of diffusion are unique to naltrexone and to the organization and delivery of alcohol treatment services, other factors are the same as those that affect the use of prescription medications more generally. Access to third-party coverage and formulary inclusion are necessary conditions for the adoption and diffusion of any new pharmaceutical technology. This paper describes current issues in drug benefit design and formulary coverage decisions, reviews publicly available information on naltrexone coverage by large health insurance programs and pharmaceutical benefit management companies, and examines whether drug benefit design constitutes a barrier to naltrexone use. Our review suggests that naltrexone is widely covered on public and private health plan formularies, though restrictions on use (i.e., quantity limits, prior authorization) are common.
Relations among heart failure severity, left ventricular loading conditions, and repolarization length in advanced heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.
In patients with heart failure (HF), low peak oxygen consumption (VO(2)) and prolonged QT interval or enhanced QT variability are associated with poor prognosis. Whether HF severity or left ventricular (LV) loading conditions can influence repolarization length is unknown. Survival, QTc interval, peak VO(2), clinical, laboratory, echocardiographic, and invasive hemodynamic data were analyzed in 154 transplant candidates; mortality was examined after a mean follow-up of 4.3 +/- 1.8 years. The relation between the QTc interval and other variables was examined using multivariate analysis and multiple correlation coefficients. Patients were stratified by peak VO(2) to study its relation with peak VO(2), mortality, loading conditions, and QTc intervals. Mean ejection fraction was 10 +/- 9%; mean cardiac index was 2.06 +/- 0.7 L/min/m(2). Seventy-one patients (47%) were dead at the end of study. Mortality and nonfatal ventricular arrythmias were higher (p <0.01) in patients with lower peak VO(2) and longer QTc intervals (p <0.001). An inverse correlation was found between QTc interval length and peak VO(2) (r = -0.790, p <0.0001). No correlation was found between QTc interval and LV loading conditions or the other analyzed variables. Thus, repolarization length measured by the QTc interval is inversely correlated with HF severity measured by peak VO(2) and is independent of LV loading conditions in patients with severe HF.