1
|
Osoro L, Zylla MM, Braunschweig F, Leyva F, Figueras J, Pürerfellner H, Merino JL, Casado-Arroyo R, Boriani G. Challenging the status quo: a scoping review of value-based care models in cardiology and electrophysiology. Europace 2024; 26:euae210. [PMID: 39158601 PMCID: PMC11393573 DOI: 10.1093/europace/euae210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/18/2024] [Accepted: 08/01/2024] [Indexed: 08/20/2024] Open
Abstract
AIMS The accomplishment of value-based healthcare (VBHC) models could save up to $1 trillion per year for healthcare systems worldwide while improving patients' wellbeing and experience. Nevertheless, its adoption and development are challenging. This review aims to provide an overview of current literature pertaining to the implementation of VBHC models used in cardiology, with a focus on cardiac electrophysiology. METHODS AND RESULTS This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Scoping Reviews. The records included in this publication were relevant documents published in PubMed, Mendeley, and ScienceDirect. The search criteria were publications about VBHC in the field of cardiology and electrophysiology published between 2006 and 2023. The implementation of VBHC models in cardiology and electrophysiology is still in its infant stages. There is a clear need to modify the current organizational structure in order to establish cross-functional teams with the patient at the centre of care. The adoption of new reimbursement schemes is crucial to moving this process forward. The implementation of technologies for data analysis and patient management, among others, poses challenges to the change process. CONCLUSION New VBHC models have the potential to improve the care process and patient experience while optimizing the costs. The implementation of this model has been insufficient mainly because it requires substantial changes in the existing infrastructures and local organization, the need to track adherence to guidelines, and the evaluation of the quality of life improvement and patient satisfaction, among others.
Collapse
Affiliation(s)
- Lucia Osoro
- Department of Cardiology, H.U.B.-Hôpital Erasme, Université Libre de Bruxelles, Rte de Lennik 808, 1070 Bruxelles, Belgium
| | - Maura M Zylla
- Department of Cardiology, HCR (Heidelberg Center for Heart Rhythm Disorders), Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- mHealth and Health Economics and PROM Committee of EHRA (European Heart Rhythm Association), Rue de la Loi 34/6th Floor B, 1040 Bruxelles, Belgium
| | - Frieder Braunschweig
- mHealth and Health Economics and PROM Committee of EHRA (European Heart Rhythm Association), Rue de la Loi 34/6th Floor B, 1040 Bruxelles, Belgium
- Department of Medicine, Solna Karolinska Institutet and ME Cardiology, Karolinska University Hospital, Norrbacka S1:02, Eugeniavagen 27, Stockholm 171 77, Sweden
| | - Francisco Leyva
- mHealth and Health Economics and PROM Committee of EHRA (European Heart Rhythm Association), Rue de la Loi 34/6th Floor B, 1040 Bruxelles, Belgium
- Department of Cardiology, Aston Medical Research Institute, Aston Medical School, Aston University, Aston Triangle, Birmingham B4 7ET, UK
| | - Josep Figueras
- European Observatory of Health Systems and Policies, Place Victor Horta 40/30 Eurostation, 1060 Brussels, Belgium
| | - Helmut Pürerfellner
- mHealth and Health Economics and PROM Committee of EHRA (European Heart Rhythm Association), Rue de la Loi 34/6th Floor B, 1040 Bruxelles, Belgium
- Ordensklinikum Linz Elisabethinen, Interne II/Kardiologie und Interne Intensivmedizin, Fadingerstraße 1, 4020 Linz, Austria
| | - Josè Luis Merino
- mHealth and Health Economics and PROM Committee of EHRA (European Heart Rhythm Association), Rue de la Loi 34/6th Floor B, 1040 Bruxelles, Belgium
- Arrhythmia-Robotic Electrophysiology Unit, La Paz University Hospital, IdiPAZ, Universidad Autónoma, Madrid, Spain
| | - Ruben Casado-Arroyo
- Department of Cardiology, H.U.B.-Hôpital Erasme, Université Libre de Bruxelles, Rte de Lennik 808, 1070 Bruxelles, Belgium
- mHealth and Health Economics and PROM Committee of EHRA (European Heart Rhythm Association), Rue de la Loi 34/6th Floor B, 1040 Bruxelles, Belgium
| | - Giuseppe Boriani
- mHealth and Health Economics and PROM Committee of EHRA (European Heart Rhythm Association), Rue de la Loi 34/6th Floor B, 1040 Bruxelles, Belgium
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy
| |
Collapse
|
2
|
Chu X, Wang R, Song G, Jiang X. Predictive value of inflammatory factors on coronary restenosis after percutaneous coronary intervention in patients with coronary heart disease: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25356. [PMID: 33787637 PMCID: PMC8021324 DOI: 10.1097/md.0000000000025356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Evidence reveals that inflammatory factors can predict coronary restenosis in patients suffering from coronary heart disease (CHD) after percutaneous coronary intervention (PCI). Perhaps, inflammatory factors are promising biomarkers for the diagnosis of coronary restenosis after PCI. However, the accuracy of inflammatory factors has not been systematically evaluated. Therefore, it is necessary to perform a meta-analysis to certify the diagnostic values of inflammatory factors on coronary restenosis after PCI. METHODS China National Knowledge Infrastructure (CNKI), Wanfang, VIP, China Biology Medicine disc (CBM), PubMed, EMBASE, Cochrane Library and Web of Science were searched for relevant studies to explore the potential diagnostic values of inflammatory factors on coronary restenosis after PCI from inception to January 2021. All data were extracted by 2 experienced researchers independently. The risk of bias about the meta-analysis was confirmed by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The data extracted were synthesized and heterogeneity was investigated as well. All of the above statistical analyses were carried out with Stata 16.0. RESULTS The results of this meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION This study clarified confusions about the specificity and sensitivity of inflammatory factors on coronary restenosis after PCI, thus further guiding their promotion and application. ETHICS AND DISSEMINATION Ethical approval will not be necessary since this systematic review and meta-analysis will not contain any private information of participants or violate their human rights. TRIAL REGISTRATION NUMBER DOI 10.17605/OSF.IO/N28JX.
Collapse
Affiliation(s)
| | | | | | - Xiaohan Jiang
- Department of Medical Genetics and Prenatal Diagnosis, Hospital Affiliated 5 to Nantong University, Taizhou People's Hospital, Taizhou 225300, Jiangsu province, China
| |
Collapse
|
3
|
Minimally invasive direct coronary bypass surgery via distal mini-sternotomy : Promising clinical results with anaortic, multivessel, all-arterial technique. Herz 2018; 44:666-672. [PMID: 29637231 DOI: 10.1007/s00059-018-4696-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/01/2018] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Minimally invasive direct coronary artery bypass grafting (MIDCAB) was developed to decrease perioperative morbidity, some of which may be related to the use of cardiopulmonary bypass and to cross-clamping of the aorta. We report our initial experience with multivessel MIDCAB via distal mini-sternotomy (DIMS). DIMS is performed to gain access to the left and right internal thoracic arteries and to reach the left anterior descending coronary artery (LAD), diagonal branches, and right coronary artery (RCA). METHODS Between January 2016 and January 2017, 12 patients with significant coronary artery disease of the LAD and the RCA underwent multivessel, all-arterial MIDCAB through a distal midline skin incision from the fourth intercostal space to the xyphoid process, with L‑ or T‑shaped division of the sternum. The mean age of the patients was 61.5 ± 5.2 years (range: 52-71 years). RESULTS We performed all-arterial revascularization using the left internal mammary artery in 12 patients, the radial artery in ten, and the right internal mammary artery in two patients. The mean number of grafts per patient was 2.08 ± 0.4 (range: 2-3). The mean length of the skin incision was 8.5 ± 1.3 cm (range: 7-11 cm). There was no perioperative ischemia, postoperative bleeding, or arrhythmia events. No postoperative cognitive dysfunction occurred. The mean hospital stay was 5.6 days. No major adverse cardiac events (MACE) occurred at the 12-month follow-up. At follow-up, all patients were in New York Heart Association class I and there were no wound complications. CONCLUSION Although MIDCAB-DIMS is technically more demanding than conventional procedures and our experience is limited, we conclude that this technique can be used safely in selected patients, with promising 12-month follow-up results.
Collapse
|
4
|
Stent fracture is associated with a higher mortality in patients with type-2 diabetes treated by implantation of a second-generation drug-eluting stent. Int J Cardiovasc Imaging 2017. [PMID: 28631105 DOI: 10.1007/s10554-017-1194-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Type 2 diabetes correlates with clinical events after the implantation of a second-generation drug-eluting stent (DES). The rate and prognostic value of stent fracture (SF) in patients with diabetes who underwent DES implantation remain unknown. A total of 1160 patients with- and 2251 without- diabetes, who underwent surveillance angiography at 1 year after DES implantation between June 2004 and August 2014, were prospectively studied. The primary endpoints included the incidence of SF and a composite major adverse cardiac event [MACE, including myocardial infarction (MI), cardiac death, and target-vessel revascularization (TVR)] at 1-year follow-up and at the end of follow-up for overall patients, and target lesion failure [TLF, including cardiac death, target vessel myocardial infarction (TVMI) and target lesion revascularization (TLR)] at the end of study for SF patients. In general, diabetes was associated with a higher rate of MACE at 1-year (18.4 vs. 12.9%) and end of follow-up (24.0 vs. 18.6%, all p < 0.001), compared with those in patients who did not have diabetes. The 1-year SF rate was comparable among patients with diabetes (n = 153, 13.2%) and non-diabetic patients (n = 273, 12.1%, p > 0.05). Diabetic patients with SF had a 2.6-fold increase of SF-related cardiac death at the end of study and threefold increase of re-repeat TLR when compared with non-diabetic patients with SF (5.9 vs. 2.2%, p = 0.040; 6.5 vs. 2.2%, p = 0.032), respectively. Given the fact that diabetes is correlated with increased MACE rate, SF in diabetic patients translates into differences in mortality and re-repeat TLR compared with the non-diabetic group.
Collapse
|