{"id":{"repo_id":"uic","oai_identifier":"oai:figshare.com:article/32995649"},"canonical_url":"https://search.dev.ndltd.org/etd/uic/oai:figshare.com:article/32995649","repository":{"repo_id":"uic","name":"University of Illinois - Chicago","base_url":"https://api.figshare.com/v2/oai"},"display":{"title":"Influenza Antivirals in Adults: Analyzing Usage Trends, GI Safety, and Cardiovascular Risk Reduction","abstract":"This dissertation explores how influenza antiviral therapy is used in everyday clinical practice among U.S. adults, with a focus on its safety profile and potential cardiovascular benefits. Seasonal influenza remains a major public health concern, contributing to substantial morbidity, mortality, and economic burden each year. Although antiviral medications are effective in reducing symptom duration and preventing severe influenza-related complications, their real-world utilization patterns, safety profiles, and broader health effects are not fully understood. Specifically, knowledge gaps remain concerning antiviral prescribing among high-risk populations, the potential risk of gastrointestinal (GI) bleeding following treatment, and the possibility that antiviral therapy may help lower the risk of cardiovascular events after influenza infection. This dissertation addresses these questions by analyzing administrative claims data in the United States, producing real-world evidence that can guide both clinical decision-making and public health policies. Chapter I provides a comprehensive background on influenza, including its epidemiology, clinical manifestations, complications, and economic burden. The chapter also discusses current diagnostic and treatment guidelines, with an emphasis on antiviral therapy, including neuraminidase inhibitors such as oseltamivir and the newer polymerase acidic endonuclease inhibitor, baloxavir marboxil. It identifies populations most vulnerable to influenza-related complications and reviews the existing literature on the effectiveness and safety of antiviral medications. Importantly, this chapter highlights three key evidence gaps that inform the aims of this dissertation: underuse of antivirals in high-risk adults, inconsistent findings on the risk of GI bleeding, and limited insight into the potential cardiovascular benefits of treatment. These knowledge gaps provide the rationale for the dissertation’s three specific aims. Chapter II addresses the first aim by evaluating how influenza antivirals are used in real-world outpatient settings across the United States. Using data from the Merative MarketScan Commercial, Medicare Supplemental, and Medicaid databases, this analysis includes influenza seasons from 2011-12 through 2023-24. It examines trends in antiviral prescribing after outpatient influenza diagnosis, geographic variation across U.S. census divisions, and gap in treatment among high-risk groups. Among more than three million influenza episodes that met inclusion criteria, only slightly more than half received antiviral treatment. Considerable variability was noted by season, region, and patient characteristics. Notably, adults considered high risk, such as those with cardiovascular, renal, or metabolic conditions, were less likely to be treated despite clear guideline recommendations prioritizing these groups. Geographic disparities were also pronounced, with some regions consistently reporting lower rates of antiviral use. Trends over time revealed a general increase in antiviral prescribing during earlier seasons, followed by a sharp decline during the COVID-19 pandemic. In more recent seasons, prescribing rates have begun to rise again, although not yet to levels that reflect consistent or sufficient improvement. These results emphasize ongoing gaps in antiviral use and the need for targeted strategies to improve treatment access for adults at high-risk of influenza complications. Chapter III examines the second aim, which is to assess whether influenza antiviral treatment is associated with an increased risk of gastrointestinal bleeding. While case reports and pharmacovigilance studies have raised concerns about bleeding, particularly with certain antiviral agents, robust population-level data has been lacking. This study uses a retrospective cohort design and propensity score matching to compare rates of GI bleeding between treated and untreated patients diagnosed with influenza. The analysis spans several influenza seasons and adjusts for a range of confounding factors, including comorbidities, concurrent medications, and healthcare utilization patterns. The findings indicate no clinically meaningful increase in GI bleeding risk among patients treated with antivirals compared to those who were not. Further subgroup analyses of specific agents, oseltamivir and baloxavir, did not reveal significant differences in risk. These results offer important reassurance regarding the gastrointestinal safety of influenza antivirals in real-world clinical settings, particularly when considered alongside earlier safety signals from spontaneous reporting systems. Chapter IV explores the third aim, which investigates whether antiviral treatment following influenza infection may lower the risk of major adverse cardiovascular events (MACE), including myocardial infarction, stroke, and heart failure exacerbations. Prior research has shown that influenza infection increases cardiovascular risk, especially in the days and weeks following diagnosis. Using a retrospective cohort design and propensity score matching, this study evaluates the association between antiviral therapy and subsequent cardiovascular outcomes. The study population includes a large, nationally representative cohort of adults, with analysis conducted both overall and in subgroups with pre-existing cardiovascular disease. The findings show that antiviral-treated patients had a lower incidence of MACE compared to untreated individuals. The protective association was strongest among those with underlying cardiovascular conditions, suggesting that early treatment may help mitigate the systemic inflammatory response and other mechanisms that link influenza to cardiac events. Secondary analyses did not demonstrate statistically significant differences between antiviral agents, likely due to limited event counts. Chapter V synthesizes the findings from all three aims and discusses their broader implications for clinical practice, public health policy, and future research directions. Taken together, the results of this dissertation reveal several important insights. First, antiviral medications remain underused, particularly among those at highest risk for severe influenza complications. Second, concerns about gastrointestinal bleeding associated with antiviral treatment are not supported by real-world data. Third, timely antiviral therapy may offer significant cardiovascular benefits, especially for patients with existing heart conditions. These findings support stronger efforts to improve awareness and implementation of treatment guidelines, especially among clinicians serving high-risk populations. In conclusion, this dissertation provides comprehensive real-world evidence on how influenza antivirals are used, how safe they are, and their potential to reduce cardiovascular risk. Through rigorous analyses of prescribing trends, gastrointestinal safety, and cardiovascular outcomes, it contributes to a deeper understanding of the broader clinical role of antiviral therapy. These findings can help shape future policies and interventions to improve antiviral access and usage, particularly among vulnerable groups. Further research should explore the comparative effectiveness of different antiviral agents, investigate the biological mechanisms underlying their cardioprotective effects, and evaluate strategies to ensure access to timely influenza treatment.","abstract_html":"This dissertation explores how influenza antiviral therapy is used in everyday clinical practice among U.S. adults, with a focus on its safety profile and potential cardiovascular benefits. Seasonal influenza remains a major public health concern, contributing to substantial morbidity, mortality, and economic burden each year. Although antiviral medications are effective in reducing symptom duration and preventing severe influenza-related complications, their real-world utilization patterns, safety profiles, and broader health effects are not fully understood. Specifically, knowledge gaps remain concerning antiviral prescribing among high-risk populations, the potential risk of gastrointestinal (GI) bleeding following treatment, and the possibility that antiviral therapy may help lower the risk of cardiovascular events after influenza infection. This dissertation addresses these questions by analyzing administrative claims data in the United States, producing real-world evidence that can guide both clinical decision-making and public health policies. Chapter I provides a comprehensive background on influenza, including its epidemiology, clinical manifestations, complications, and economic burden. The chapter also discusses current diagnostic and treatment guidelines, with an emphasis on antiviral therapy, including neuraminidase inhibitors such as oseltamivir and the newer polymerase acidic endonuclease inhibitor, baloxavir marboxil. It identifies populations most vulnerable to influenza-related complications and reviews the existing literature on the effectiveness and safety of antiviral medications. Importantly, this chapter highlights three key evidence gaps that inform the aims of this dissertation: underuse of antivirals in high-risk adults, inconsistent findings on the risk of GI bleeding, and limited insight into the potential cardiovascular benefits of treatment. These knowledge gaps provide the rationale for the dissertation’s three specific aims. Chapter II addresses the first aim by evaluating how influenza antivirals are used in real-world outpatient settings across the United States. Using data from the Merative MarketScan Commercial, Medicare Supplemental, and Medicaid databases, this analysis includes influenza seasons from 2011-12 through 2023-24. It examines trends in antiviral prescribing after outpatient influenza diagnosis, geographic variation across U.S. census divisions, and gap in treatment among high-risk groups. Among more than three million influenza episodes that met inclusion criteria, only slightly more than half received antiviral treatment. Considerable variability was noted by season, region, and patient characteristics. Notably, adults considered high risk, such as those with cardiovascular, renal, or metabolic conditions, were less likely to be treated despite clear guideline recommendations prioritizing these groups. Geographic disparities were also pronounced, with some regions consistently reporting lower rates of antiviral use. Trends over time revealed a general increase in antiviral prescribing during earlier seasons, followed by a sharp decline during the COVID-19 pandemic. In more recent seasons, prescribing rates have begun to rise again, although not yet to levels that reflect consistent or sufficient improvement. These results emphasize ongoing gaps in antiviral use and the need for targeted strategies to improve treatment access for adults at high-risk of influenza complications. Chapter III examines the second aim, which is to assess whether influenza antiviral treatment is associated with an increased risk of gastrointestinal bleeding. While case reports and pharmacovigilance studies have raised concerns about bleeding, particularly with certain antiviral agents, robust population-level data has been lacking. This study uses a retrospective cohort design and propensity score matching to compare rates of GI bleeding between treated and untreated patients diagnosed with influenza. The analysis spans several influenza seasons and adjusts for a range of confounding factors, including comorbidities, concurrent medications, and healthcare utilization patterns. The findings indicate no clinically meaningful increase in GI bleeding risk among patients treated with antivirals compared to those who were not. Further subgroup analyses of specific agents, oseltamivir and baloxavir, did not reveal significant differences in risk. These results offer important reassurance regarding the gastrointestinal safety of influenza antivirals in real-world clinical settings, particularly when considered alongside earlier safety signals from spontaneous reporting systems. Chapter IV explores the third aim, which investigates whether antiviral treatment following influenza infection may lower the risk of major adverse cardiovascular events (MACE), including myocardial infarction, stroke, and heart failure exacerbations. Prior research has shown that influenza infection increases cardiovascular risk, especially in the days and weeks following diagnosis. Using a retrospective cohort design and propensity score matching, this study evaluates the association between antiviral therapy and subsequent cardiovascular outcomes. The study population includes a large, nationally representative cohort of adults, with analysis conducted both overall and in subgroups with pre-existing cardiovascular disease. The findings show that antiviral-treated patients had a lower incidence of MACE compared to untreated individuals. The protective association was strongest among those with underlying cardiovascular conditions, suggesting that early treatment may help mitigate the systemic inflammatory response and other mechanisms that link influenza to cardiac events. Secondary analyses did not demonstrate statistically significant differences between antiviral agents, likely due to limited event counts. Chapter V synthesizes the findings from all three aims and discusses their broader implications for clinical practice, public health policy, and future research directions. Taken together, the results of this dissertation reveal several important insights. First, antiviral medications remain underused, particularly among those at highest risk for severe influenza complications. Second, concerns about gastrointestinal bleeding associated with antiviral treatment are not supported by real-world data. Third, timely antiviral therapy may offer significant cardiovascular benefits, especially for patients with existing heart conditions. These findings support stronger efforts to improve awareness and implementation of treatment guidelines, especially among clinicians serving high-risk populations. In conclusion, this dissertation provides comprehensive real-world evidence on how influenza antivirals are used, how safe they are, and their potential to reduce cardiovascular risk. Through rigorous analyses of prescribing trends, gastrointestinal safety, and cardiovascular outcomes, it contributes to a deeper understanding of the broader clinical role of antiviral therapy. These findings can help shape future policies and interventions to improve antiviral access and usage, particularly among vulnerable groups. Further research should explore the comparative effectiveness of different antiviral agents, investigate the biological mechanisms underlying their cardioprotective effects, and evaluate strategies to ensure access to timely influenza treatment.","abstract_has_math":false,"creators":["Jyotirmoy Sarker (24400583)"],"institution":null,"degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2026,"date_issued":"2026-05-01T00:00:00Z","date_published":"2026-05-01T00:00:00Z","updated_at":"2026-07-27T21:33:54Z","subjects":["Health Sciences, Public Health","Health Sciences, Pharmacy","Health Sciences, Epidemiology","Pharmacoepidemiology","Observational resaerch","Health"],"languages":[],"rights":["In Copyright","Open Access after 2031-05-01"],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://doi.org/10.25417/uic.32995649.v1","outbound_label":"DOI","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Jyotirmoy Sarker (24400583)"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2026-05-01T00:00:00Z"]},{"key":"dc:relation","label":"Dc Relation","values":["https://figshare.com/articles/thesis/Influenza_Antivirals_in_Adults_Analyzing_Usage_Trends_GI_Safety_and_Cardiovascular_Risk_Reduction/32995649"]},{"key":"dc:type","label":"Dc Type","values":["Text","Thesis"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Health Sciences, Public Health","Health Sciences, Pharmacy","Health Sciences, Epidemiology","Pharmacoepidemiology","Observational resaerch","Health"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:rights","label":"Dc Rights","values":["In Copyright","Open Access after 2031-05-01"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["10.25417/uic.32995649.v1"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["This dissertation explores how influenza antiviral therapy is used in everyday clinical practice among U.S. adults, with a focus on its safety profile and potential cardiovascular benefits. Seasonal influenza remains a major public health concern, contributing to substantial morbidity, mortality, and economic burden each year. Although antiviral medications are effective in reducing symptom duration and preventing severe influenza-related complications, their real-world utilization patterns, safety profiles, and broader health effects are not fully understood. Specifically, knowledge gaps remain concerning antiviral prescribing among high-risk populations, the potential risk of gastrointestinal (GI) bleeding following treatment, and the possibility that antiviral therapy may help lower the risk of cardiovascular events after influenza infection. This dissertation addresses these questions by analyzing administrative claims data in the United States, producing real-world evidence that can guide both clinical decision-making and public health policies. Chapter I provides a comprehensive background on influenza, including its epidemiology, clinical manifestations, complications, and economic burden. The chapter also discusses current diagnostic and treatment guidelines, with an emphasis on antiviral therapy, including neuraminidase inhibitors such as oseltamivir and the newer polymerase acidic endonuclease inhibitor, baloxavir marboxil. It identifies populations most vulnerable to influenza-related complications and reviews the existing literature on the effectiveness and safety of antiviral medications. Importantly, this chapter highlights three key evidence gaps that inform the aims of this dissertation: underuse of antivirals in high-risk adults, inconsistent findings on the risk of GI bleeding, and limited insight into the potential cardiovascular benefits of treatment. These knowledge gaps provide the rationale for the dissertation’s three specific aims. Chapter II addresses the first aim by evaluating how influenza antivirals are used in real-world outpatient settings across the United States. Using data from the Merative MarketScan Commercial, Medicare Supplemental, and Medicaid databases, this analysis includes influenza seasons from 2011-12 through 2023-24. It examines trends in antiviral prescribing after outpatient influenza diagnosis, geographic variation across U.S. census divisions, and gap in treatment among high-risk groups. Among more than three million influenza episodes that met inclusion criteria, only slightly more than half received antiviral treatment. Considerable variability was noted by season, region, and patient characteristics. Notably, adults considered high risk, such as those with cardiovascular, renal, or metabolic conditions, were less likely to be treated despite clear guideline recommendations prioritizing these groups. Geographic disparities were also pronounced, with some regions consistently reporting lower rates of antiviral use. Trends over time revealed a general increase in antiviral prescribing during earlier seasons, followed by a sharp decline during the COVID-19 pandemic. In more recent seasons, prescribing rates have begun to rise again, although not yet to levels that reflect consistent or sufficient improvement. These results emphasize ongoing gaps in antiviral use and the need for targeted strategies to improve treatment access for adults at high-risk of influenza complications. Chapter III examines the second aim, which is to assess whether influenza antiviral treatment is associated with an increased risk of gastrointestinal bleeding. While case reports and pharmacovigilance studies have raised concerns about bleeding, particularly with certain antiviral agents, robust population-level data has been lacking. This study uses a retrospective cohort design and propensity score matching to compare rates of GI bleeding between treated and untreated patients diagnosed with influenza. The analysis spans several influenza seasons and adjusts for a range of confounding factors, including comorbidities, concurrent medications, and healthcare utilization patterns. The findings indicate no clinically meaningful increase in GI bleeding risk among patients treated with antivirals compared to those who were not. Further subgroup analyses of specific agents, oseltamivir and baloxavir, did not reveal significant differences in risk. These results offer important reassurance regarding the gastrointestinal safety of influenza antivirals in real-world clinical settings, particularly when considered alongside earlier safety signals from spontaneous reporting systems. Chapter IV explores the third aim, which investigates whether antiviral treatment following influenza infection may lower the risk of major adverse cardiovascular events (MACE), including myocardial infarction, stroke, and heart failure exacerbations. Prior research has shown that influenza infection increases cardiovascular risk, especially in the days and weeks following diagnosis. Using a retrospective cohort design and propensity score matching, this study evaluates the association between antiviral therapy and subsequent cardiovascular outcomes. The study population includes a large, nationally representative cohort of adults, with analysis conducted both overall and in subgroups with pre-existing cardiovascular disease. The findings show that antiviral-treated patients had a lower incidence of MACE compared to untreated individuals. The protective association was strongest among those with underlying cardiovascular conditions, suggesting that early treatment may help mitigate the systemic inflammatory response and other mechanisms that link influenza to cardiac events. Secondary analyses did not demonstrate statistically significant differences between antiviral agents, likely due to limited event counts. Chapter V synthesizes the findings from all three aims and discusses their broader implications for clinical practice, public health policy, and future research directions. Taken together, the results of this dissertation reveal several important insights. First, antiviral medications remain underused, particularly among those at highest risk for severe influenza complications. Second, concerns about gastrointestinal bleeding associated with antiviral treatment are not supported by real-world data. Third, timely antiviral therapy may offer significant cardiovascular benefits, especially for patients with existing heart conditions. These findings support stronger efforts to improve awareness and implementation of treatment guidelines, especially among clinicians serving high-risk populations. In conclusion, this dissertation provides comprehensive real-world evidence on how influenza antivirals are used, how safe they are, and their potential to reduce cardiovascular risk. Through rigorous analyses of prescribing trends, gastrointestinal safety, and cardiovascular outcomes, it contributes to a deeper understanding of the broader clinical role of antiviral therapy. These findings can help shape future policies and interventions to improve antiviral access and usage, particularly among vulnerable groups. Further research should explore the comparative effectiveness of different antiviral agents, investigate the biological mechanisms underlying their cardioprotective effects, and evaluate strategies to ensure access to timely influenza treatment."]},{"key":"dc:title","label":"Title","values":["Influenza Antivirals in Adults: Analyzing Usage Trends, GI Safety, and Cardiovascular Risk Reduction"]}]}],"canonical_facts":{"dc:creator":["Jyotirmoy Sarker (24400583)"],"dc:date":["2026-05-01T00:00:00Z"],"dc:description":["This dissertation explores how influenza antiviral therapy is used in everyday clinical practice among U.S. adults, with a focus on its safety profile and potential cardiovascular benefits. Seasonal influenza remains a major public health concern, contributing to substantial morbidity, mortality, and economic burden each year. Although antiviral medications are effective in reducing symptom duration and preventing severe influenza-related complications, their real-world utilization patterns, safety profiles, and broader health effects are not fully understood. Specifically, knowledge gaps remain concerning antiviral prescribing among high-risk populations, the potential risk of gastrointestinal (GI) bleeding following treatment, and the possibility that antiviral therapy may help lower the risk of cardiovascular events after influenza infection. This dissertation addresses these questions by analyzing administrative claims data in the United States, producing real-world evidence that can guide both clinical decision-making and public health policies. Chapter I provides a comprehensive background on influenza, including its epidemiology, clinical manifestations, complications, and economic burden. The chapter also discusses current diagnostic and treatment guidelines, with an emphasis on antiviral therapy, including neuraminidase inhibitors such as oseltamivir and the newer polymerase acidic endonuclease inhibitor, baloxavir marboxil. It identifies populations most vulnerable to influenza-related complications and reviews the existing literature on the effectiveness and safety of antiviral medications. Importantly, this chapter highlights three key evidence gaps that inform the aims of this dissertation: underuse of antivirals in high-risk adults, inconsistent findings on the risk of GI bleeding, and limited insight into the potential cardiovascular benefits of treatment. These knowledge gaps provide the rationale for the dissertation’s three specific aims. Chapter II addresses the first aim by evaluating how influenza antivirals are used in real-world outpatient settings across the United States. Using data from the Merative MarketScan Commercial, Medicare Supplemental, and Medicaid databases, this analysis includes influenza seasons from 2011-12 through 2023-24. It examines trends in antiviral prescribing after outpatient influenza diagnosis, geographic variation across U.S. census divisions, and gap in treatment among high-risk groups. Among more than three million influenza episodes that met inclusion criteria, only slightly more than half received antiviral treatment. Considerable variability was noted by season, region, and patient characteristics. Notably, adults considered high risk, such as those with cardiovascular, renal, or metabolic conditions, were less likely to be treated despite clear guideline recommendations prioritizing these groups. Geographic disparities were also pronounced, with some regions consistently reporting lower rates of antiviral use. Trends over time revealed a general increase in antiviral prescribing during earlier seasons, followed by a sharp decline during the COVID-19 pandemic. In more recent seasons, prescribing rates have begun to rise again, although not yet to levels that reflect consistent or sufficient improvement. These results emphasize ongoing gaps in antiviral use and the need for targeted strategies to improve treatment access for adults at high-risk of influenza complications. Chapter III examines the second aim, which is to assess whether influenza antiviral treatment is associated with an increased risk of gastrointestinal bleeding. While case reports and pharmacovigilance studies have raised concerns about bleeding, particularly with certain antiviral agents, robust population-level data has been lacking. This study uses a retrospective cohort design and propensity score matching to compare rates of GI bleeding between treated and untreated patients diagnosed with influenza. The analysis spans several influenza seasons and adjusts for a range of confounding factors, including comorbidities, concurrent medications, and healthcare utilization patterns. The findings indicate no clinically meaningful increase in GI bleeding risk among patients treated with antivirals compared to those who were not. Further subgroup analyses of specific agents, oseltamivir and baloxavir, did not reveal significant differences in risk. These results offer important reassurance regarding the gastrointestinal safety of influenza antivirals in real-world clinical settings, particularly when considered alongside earlier safety signals from spontaneous reporting systems. Chapter IV explores the third aim, which investigates whether antiviral treatment following influenza infection may lower the risk of major adverse cardiovascular events (MACE), including myocardial infarction, stroke, and heart failure exacerbations. Prior research has shown that influenza infection increases cardiovascular risk, especially in the days and weeks following diagnosis. Using a retrospective cohort design and propensity score matching, this study evaluates the association between antiviral therapy and subsequent cardiovascular outcomes. The study population includes a large, nationally representative cohort of adults, with analysis conducted both overall and in subgroups with pre-existing cardiovascular disease. The findings show that antiviral-treated patients had a lower incidence of MACE compared to untreated individuals. The protective association was strongest among those with underlying cardiovascular conditions, suggesting that early treatment may help mitigate the systemic inflammatory response and other mechanisms that link influenza to cardiac events. Secondary analyses did not demonstrate statistically significant differences between antiviral agents, likely due to limited event counts. Chapter V synthesizes the findings from all three aims and discusses their broader implications for clinical practice, public health policy, and future research directions. Taken together, the results of this dissertation reveal several important insights. First, antiviral medications remain underused, particularly among those at highest risk for severe influenza complications. Second, concerns about gastrointestinal bleeding associated with antiviral treatment are not supported by real-world data. Third, timely antiviral therapy may offer significant cardiovascular benefits, especially for patients with existing heart conditions. These findings support stronger efforts to improve awareness and implementation of treatment guidelines, especially among clinicians serving high-risk populations. In conclusion, this dissertation provides comprehensive real-world evidence on how influenza antivirals are used, how safe they are, and their potential to reduce cardiovascular risk. Through rigorous analyses of prescribing trends, gastrointestinal safety, and cardiovascular outcomes, it contributes to a deeper understanding of the broader clinical role of antiviral therapy. These findings can help shape future policies and interventions to improve antiviral access and usage, particularly among vulnerable groups. Further research should explore the comparative effectiveness of different antiviral agents, investigate the biological mechanisms underlying their cardioprotective effects, and evaluate strategies to ensure access to timely influenza treatment."],"dc:identifier":["10.25417/uic.32995649.v1"],"dc:relation":["https://figshare.com/articles/thesis/Influenza_Antivirals_in_Adults_Analyzing_Usage_Trends_GI_Safety_and_Cardiovascular_Risk_Reduction/32995649"],"dc:rights":["In Copyright","Open Access after 2031-05-01"],"dc:subject":["Health Sciences, Public Health","Health Sciences, Pharmacy","Health Sciences, Epidemiology","Pharmacoepidemiology","Observational resaerch","Health"],"dc:title":["Influenza Antivirals in Adults: Analyzing Usage Trends, GI Safety, and Cardiovascular Risk Reduction"],"dc:type":["Text","Thesis"]},"updated_at":"2026-07-27T21:33:54Z"}