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Wiethoff I, Evers SMAA, Michels M, Hiligsmann M. An introduction to health technology assessment and health economic evaluation: an online self-learning course. Neth Heart J 2023; 31:219-225. [PMID: 37171709 DOI: 10.1007/s12471-023-01777-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 05/13/2023] Open
Abstract
Cardiovascular diseases impose an enormous burden on patients and society. New health technologies promise to lower this burden; however, novel treatments often come at a high cost. In the Netherlands, health technology assessment (HTA) is increasingly being used to inform policy bodies about the optimal distribution of scarce healthcare resources and to guide decision-making about financing and reimbursement. In particular, economic evaluations, as one pillar of HTA, are frequently used to compare the costs and effects of different interventions. This paper aims to define HTA and its relevance to healthcare policy as well as providing a comprehensive overview of the methodology of economic evaluations targeting health professionals and researchers with limited prior knowledge of this subject. Accordingly, different types of economic evaluations are introduced, together with their respective costs and outcomes. Further, the results of economic evaluations are explained, along with techniques for performing them and methods for coping with uncertainty. In addition to this paper-based learning format, each chapter is complemented by a video lecture with further information and practical examples, helping to better understand and analyse health economic studies.
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Affiliation(s)
- Isabell Wiethoff
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Centre for Economic Evaluation and Machine Learning, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, Rotterdam, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Kinugawa K, Sato N, Inomata T, Yasuda M, Shimakawa T, Fukuta Y. A Prospective, Multicenter, Post-Marketing Surveillance Study to Evaluate the Safety and Effectiveness of Tolvaptan in Patients with Reduced, Preserved, and Mid-Range Ejection Fraction Heart Failure. Int Heart J 2019; 60:1123-1130. [PMID: 31484861 DOI: 10.1536/ihj.18-671] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Tolvaptan, a vasopressin V2 receptor antagonist, is approved in Japan for the treatment of fluid retention in patients with heart failure (HF), and in the United States for hyponatremia. The efficacy and safety of tolvaptan in patients with HF with reduced ejection fraction (HFrEF) have been demonstrated previously. However, its efficacy in patients with HF having preserved (HFpEF) and mid-range (HFmrEF) ejection fraction (EF) remains uncertain. The present subgroup analysis from the post-marketing surveillance SMILE Study aims to explore the efficacy and safety of tolvaptan across the HF subgroups (HFrEF, HFpEF, and HFmrEF).Patients with HF accompanied by fluid retention who received tolvaptan were enrolled. Primary endpoints were: change in body weight, 24-hour urine volume, congestive symptoms, and safety over 14-day treatment. Of the 3,349 patients enrolled, left ventricular EF data were available for 1,741 patients; 45.7% had HFpEF. Tolvaptan treatment resulted in body weight reduction and increases in 24-hour urine volume across the 3 subgroups. Congestive symptoms significantly improved over the 14-day treatment in all subgroups. The frequency of adverse events (AEs) was comparable across the subgroups; thirst was the most common AE.Tolvaptan provides a safe and effective option for treating fluid retention in patients with HFpEF, as well as HFmrEF and HFrEF.
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Affiliation(s)
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital
| | - Takayuki Inomata
- Department of Cardiology, Kitasato University Kitasato Institute Hospital
| | | | | | - Yasuhiko Fukuta
- Department of Pharmacovigilance, Otsuka Pharmaceutical Co., Ltd
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Kanwar MK, Bailey S, Murali S. Challenges and Future Directions in Left Ventricular Assist Device Therapy. Crit Care Clin 2018; 34:479-492. [PMID: 29907278 DOI: 10.1016/j.ccc.2018.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The clinical use of left ventricular assist devices (LVADs) in the growing epidemic of heart failure has improved quality of life and long-term survival for this otherwise devastating disease. The current generation of commercially available devices offers a smaller profile that simplifies surgical implantation, a design that optimizes blood flow characteristics, with less adverse events and improved durability than their predecessors. Despite this, the risk for adverse events remains significant, as do burdens for patients and their caregivers. Appropriate patient selection remains key to optimal LVAD outcomes.
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Affiliation(s)
- Manreet K Kanwar
- Section of Heart Failure/Transplant/MCS and Pulmonary Hypertension, Cardiovascular Institute, Allegheny Health Network, Temple University School of Medicine, 320 East North Avenue, 16th Floor ST, Pittsburgh, PA 15212, USA.
| | - Stephen Bailey
- Department of Cardiothoracic Surgery, Cardiovascular Institute, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15212, USA
| | - Srinivas Murali
- Department of Cardiothoracic Surgery, Cardiovascular Institute, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15212, USA
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Leary PJ. Causality, Correlation, and Cardiac Disease: Does Smoking Cause Cardiac Hypertrophy and Diastolic Dysfunction? Circ Cardiovasc Imaging 2018; 9:e005441. [PMID: 27625350 DOI: 10.1161/circimaging.116.005441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Peter J Leary
- From the Department of Medicine, University of Washington, Seattle.
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Sandesara PB, Samman-Tahhan A, Topel M, Venkatesh S, O'Neal WT. Effect of Cigarette Smoking on Risk for Adverse Events in Patients With Heart Failure and Preserved Ejection Fraction. Am J Cardiol 2018; 122:400-404. [PMID: 30201107 DOI: 10.1016/j.amjcard.2018.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/31/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
Smoking is an important risk factor in the development of heart failure with preserved ejection (HFpEF), and previous reports have identified smoking as a significant predictor of death in this population. However, the relation between smoking and heart failure-specific outcomes has not been examined in patients with HFpEF. This analysis included 1,717 patients (mean age = 71 ± 10 years; 50% men; 78% white) with HFpEF enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial from the Americas. Smoking was ascertained by self-reported history and categorized as never, former, or current. Multivariable Cox regression was used to examine the risk of hospitalization for heart failure, death, and cardiovascular death across smoking categories. There were 116 current smokers (7%), 871 former smokers (51%), and 729 never smokers (42%) in this analysis. Current smoking was associated with an increased risk of hospitalization for heart failure (never: hazard ratio [HR] 1.0; former: HR 1.25, 95% confidence interval [CI] 0.99 to 1.57; current: HR 1.68, 95% CI 1.08 to 2.61), death (never: HR 1.0; former: HR 1.02, 95% CI 0.81 to 1.29; current: HR 1.82, 95% CI 1.19 to 2.78), and cardiovascular death (never: HR 1.0; former: HR 1.00, 95% CI 0.74 to 1.35; current: HR 1.85, 95% CI 1.09 to 3.24) compared with former or never smokers in a multivariable model adjusted for cardiovascular risk factors. A similar increased risk of hospitalization for heart failure (former: HR 1.0; current: HR 1.54, 95% CI 1.01, 2.36), death (former: HR 1.0; current: HR 1.81, 95% CI 1.19, 2.75), and cardiovascular death (former: HR 1.0; current: HR 1.76, 95% CI 1.04, 2.98) was observed for current smokers when we limited the analysis to those with a history of smoking. In conclusion, current smoking is associated with an increased risk for adverse outcomes in HFpEF, including hospitalization for heart failure. Smoking cessation strategies possibly have a role to reduce the risk for adverse cardiovascular outcomes in patients with HFpEF.
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Leary PJ, Tedford RJ, Bluemke DA, Bristow MR, Heckbert SR, Kawut SM, Krieger EV, Lima JA, Masri CS, Ralph DD, Shea S, Weiss NS, Kronmal RA. Histamine H2 Receptor Antagonists, Left Ventricular Morphology, and Heart Failure Risk: The MESA Study. J Am Coll Cardiol 2016; 67:1544-1552. [PMID: 27150686 PMCID: PMC4860615 DOI: 10.1016/j.jacc.2016.01.045] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/15/2016] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Myocardial H2 receptor activation may promote cardiac fibrosis and apoptosis in pre-clinical models and histamine H2 receptor antagonist (H2RA) use may improve symptoms in participants with heart failure (HF); however, relationships between H2RA use, incident HF, and longitudinal change in left ventricular (LV) morphology are not known. OBJECTIVES This study sought to determine whether H2RA use is associated with incident HF and change in LV morphology over time. METHODS We included 6,378 men and women from MESA (Multi-Ethnic Study of Atherosclerosis), a multicenter prospective observational cohort of participants without cardiovascular disease at baseline. Cox proportional hazards were used to estimate the association between H2RA use and incident HF in adjusted models. In participants with cardiac magnetic resonance imaging, associations between H2RA use, baseline LV morphology (n = 4,691), and longitudinal change in the LV (n = 2,806) were estimated using linear regression. RESULTS H2RAs were used by 313 participants but not by the other 6,065 individuals. During a median follow-up of 11.2 years, 236 participants developed HF. In adjusted models, baseline H2RA use relative to nonuse was associated with 62% lower risk for incident HF (p = 0.02). H2RA use was associated with preserved stroke volume, LV end-diastolic volume, and mass/volume ratio as measured by cardiac magnetic resonance imaging over approximately 10 years (all p < 0.05). There were no associations between H2RA use and LV mass or ejection fraction. CONCLUSIONS H2RA use was associated with reduced risk for incident HF. Left heart morphology over time suggests less age-related change in H2RA users. These associations suggest histamine signaling may be important in the pathogenesis of HF. (Multi-Ethnic Study of Atherosclerosis [MESA]; NCT00005487).
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Affiliation(s)
- Peter J Leary
- Department of Medicine, University of Washington, Seattle, Washington.
| | - Ryan J Tedford
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - David A Bluemke
- National Institutes of Health Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland
| | | | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Steven M Kawut
- Departments of Medicine and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric V Krieger
- Department of Medicine, University of Washington, Seattle, Washington
| | - Joao A Lima
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland; Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Carolina S Masri
- Department of Medicine, University of Washington, Seattle, Washington
| | - David D Ralph
- Department of Medicine, University of Washington, Seattle, Washington
| | - Steven Shea
- Departments of Medicine and Epidemiology, Columbia University, New York City, New York
| | - Noel S Weiss
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Richard A Kronmal
- Department of Biostatistics, University of Washington, Seattle, Washington
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Jalil JE, Ocaranza MP. Estrogens and myocardial chymase: new insights into pathological hypertrophy and remodeling. Hypertension 2014; 65:271-2. [PMID: 25403603 DOI: 10.1161/hypertensionaha.114.04375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Jorge E Jalil
- From the School of Medicine, Division of Cardiovascular Diseases, Molecular Cardiology Laboratory, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - María P Ocaranza
- From the School of Medicine, Division of Cardiovascular Diseases, Molecular Cardiology Laboratory, Pontificia Universidad Católica de Chile, Santiago, Chile
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