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Cerqueiro-González JM, González-Franco A, Fernández-Rodríguez JM, Martínez-Litago E, Pérez-Silvestre J, Salamanca-Bautista P, Morales-Rull L, Conde-Martel A, Casado J, Manzano-Espinosa L, Aramburu-Bodas O. Basic action protocol for the outpatient management of chronic heart failure of the Spanish society of internal medicine. Rev Clin Esp 2024:S2254-8874(24)00113-9. [PMID: 39216808 DOI: 10.1016/j.rceng.2024.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Chronic heart failure (CHF) represents a challenge for the healthy system due to its high prevalence, high burden of morbidity and mortality, and high consumption of health resources. To address this problem, it is necessary to develop efficient management strategies that include both hospital care and outpatient care. The primary objective is to stabilize the patient and prevent decompensation, with the consequent improvement in quality of life, reduction in hospital admissions and emergency department care, and, consequently, reduction in healthcare costs. In this context, the heart failure and atrial fibrilation working group of the Spanish Society of Internal Medicine has developed a protocol for the management of outpatient CHF, that addresses, from the perspective of Internal medicine, all the problems suffered by the patient with CHF. This protocol aims to optimize pharmacological treatment, control cardiovascular risk factors and various comorbidities, educate the patient and their environment about the disease, promote adherence to treatment and stablish follow-up adapted to their condition.
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Affiliation(s)
| | - A González-Franco
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - E Martínez-Litago
- Servicio de Medicina Interna, Hospital Santa Bárbara de Puertollano, Spain
| | | | - P Salamanca-Bautista
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Macarena, Universidad de Sevilla, Spain
| | - L Morales-Rull
- Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Spain
| | - A Conde-Martel
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Doctor Negrín, Spain
| | - J Casado
- Servicio de Medicina Interna, Hospital Universitario de Getafe, Madrid, Spain
| | - L Manzano-Espinosa
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - O Aramburu-Bodas
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Macarena, Universidad de Sevilla, Spain
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2
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García-Conejo C, Roldán-Jiménez C, Ramirez-Pérez L, Díaz-Balboa E, Cuesta-Vargas A. [Self-care education during Cardiac Rehabilitation programs for patients with Heart Failure with preserved Ejection Fraction: a Delphi Study]. Aten Primaria 2024; 56:103030. [PMID: 39018719 PMCID: PMC11305252 DOI: 10.1016/j.aprim.2024.103030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/31/2024] [Accepted: 06/02/2024] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVES To develop a decalogue of self-care competencies to manage educational intervention during Cardiac Rehabilitation (CR) programs in Heart Failure with preserved Ejection Fraction (HFpEF) patients through multidisciplinary consensus. DESIGN 3-round e-Delphi study using an initial questionnaire of 23 competencies based on the main recommendations of the CR and self-care guidelines. SITE: It was framed under the ethics of a randomised clinical trial developed at the Regional Hospital of Malaga. The survey was designed and disseminated as an online questionnaire. PARTICIPANTS The expert panel comprised two patients with HFpEF and 13 healthcare professionals from Internal Medicine (n=3), Cardiology (n=2), Physiotherapy (n=3), Nursing (n=3) and Occupational Therapy (n=2). METHOD The analysis of results included the content validity index, the percentage of agreement, and the concordance using Fleiss Kappa and Krippendorff's alpha. RESULTS After the third round, 20 self-care competencies were identified, grouped into 12 domains, with sufficient consensus for their inclusion in the decalogue. CONCLUSIONS The decalogue of self-care competencies generated from the multidisciplinary consensus guides education in patients with HFpEF, systematically addressing educational content tailored to patients for clinical practice in CR programs.
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Affiliation(s)
- Celia García-Conejo
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga Málaga, España; Grupo de Investigación Clinimetría F14, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29010 Málaga, España
| | - Cristina Roldán-Jiménez
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga Málaga, España; Grupo de Investigación Clinimetría F14, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29010 Málaga, España
| | - Laura Ramirez-Pérez
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga Málaga, España; Grupo de Investigación Clinimetría F14, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29010 Málaga, España
| | - Estíbaliz Díaz-Balboa
- Grupo de Investigación Clinimetría F14, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29010 Málaga, España; Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Facultad de Fisioterapia, Campus de Oza, Universidade da Coruña, Coruña, España; Grupo de Cardiología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Coruña, España
| | - Antonio Cuesta-Vargas
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga Málaga, España; Grupo de Investigación Clinimetría F14, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29010 Málaga, España.
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3
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Santos JAR, Grant R, Di Tanna GL. Bayesian Meta-Analysis of Health State Utility Values: A Tutorial with a Practical Application in Heart Failure. PHARMACOECONOMICS 2024; 42:721-735. [PMID: 38767714 PMCID: PMC11180161 DOI: 10.1007/s40273-024-01387-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/22/2024]
Abstract
Researchers incorporate health state utility values as inputs to inform economic models. However, for a particular health state or condition, multiple utility values derived from different studies typically exist and a single study is often insufficient to represent the best available source of utility needed to inform policy decisions. The purpose of this paper is to provide an introductory guidance for conducting Bayesian meta-analysis of health state utility values to generate a single parameter input for economic evaluation, using R. The tutorial is illustrated using data from a systematic review of health state utilities of patients with heart failure, with 21 studies that reported utilities measured using the EuroQol-5D (EQ-5D). Explanations, key considerations and suggested readings are provided for each step of the tutorial, adhering to a clear workflow for conducting Bayesian meta-analysis: (1) setting-up the data; (2) employing methods to impute missing standard deviations; (3) defining the priors; (4) fitting the model; (5) diagnosing model convergence; (6) interpreting the results; and (7) performing sensitivity analyses. The posterior distributions for the pooled effect size (i.e. mean health state utility) and between-study heterogeneity are discussed and interpreted in light of the data, priors and models used. We hope that this tutorial will foster interest in Bayesian methods and their applications in the meta-analysis of utilities.
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Affiliation(s)
- Joseph Alvin Ramos Santos
- Department of Business Economics, Health and Social Care (DEASS), University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Manno, Ticino, Switzerland
| | - Robert Grant
- BayesCamp Ltd, Winchester, UK
- Kingston University, London, UK
| | - Gian Luca Di Tanna
- Department of Business Economics, Health and Social Care (DEASS), University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Manno, Ticino, Switzerland.
- Department of Clinical Research (DCR), University of Bern, Bern, Switzerland.
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Wiethoff I, Sikking M, Evers S, Gabrio A, Henkens M, Michels M, Verdonschot J, Heymans S, Hiligsmann M. Quality of life and societal costs in patients with dilated cardiomyopathy. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:334-344. [PMID: 37709575 PMCID: PMC11187720 DOI: 10.1093/ehjqcco/qcad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/16/2023]
Abstract
AIMS Dilated cardiomyopathy (DCM) is a major cause of heart failure impairing patient wellbeing and imposing a substantial economic burden on society, but respective data are missing. This study aims to measure the quality of life (QoL) and societal costs of DCM patients. METHODS AND RESULTS A cross-sectional evaluation of QoL and societal costs of DCM patients was performed through the 5-level EuroQol and the Medical Consumption Questionnaire and Productivity Cost Questionnaire, respectively. QoL was translated into numerical values (i.e. utilities). Costs were measured from a Dutch societal perspective. Final costs were extrapolated to 1 year, reported in 2022 Euros, and compared between DCM severity according to NYHA classes. A total of 550 DCM patients from the Maastricht cardiomyopathy registry were included. Mean age was 61 years, and 34% were women. Overall utility was slightly lower for DCM patients than the population mean (0.840 vs. 0.869, P = 0.225). Among EQ-5D dimensions, DCM patients scored lowest in 'usual activities'. Total societal DCM costs were €14 843 per patient per year. Cost drivers were productivity losses (€7037) and medical costs (€4621). Patients with more symptomatic DCM (i.e. NYHA class III or IV) had significantly higher average DCM costs per year compared to less symptomatic DCM (€31 099 vs. €11 446, P < 0.001) and significantly lower utilities (0.631 vs. 0.883, P < 0.001). CONCLUSION DCM is associated with high societal costs and reduced QoL, in particular with high DCM severity.
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Affiliation(s)
- Isabell Wiethoff
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Maurits Sikking
- Department of Cardiology, CARIM, Maastricht University Medical Centre, 6229 ER Maastricht, The Netherlands
| | - Silvia Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre for Economic Evaluation and Machine Learning, 3500 AS Utrecht, The Netherlands
| | - Andrea Gabrio
- Department of Methodology and Statistics, Faculty of Health Medicine and Life Science, Maastricht University, 6229 HA Maastricht, The Netherlands
| | - Michiel Henkens
- Department of Cardiology, CARIM, Maastricht University Medical Centre, 6229 ER Maastricht, The Netherlands
- Department of Pathology, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
- Netherlands Heart Institute (NLHI), 3511 EP Utrecht, The Netherlands
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus MC, 3000 CA Rotterdam, The Netherlands
| | - Job Verdonschot
- Department of Cardiology, CARIM, Maastricht University Medical Centre, 6229 ER Maastricht, The Netherlands
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
| | - Stephane Heymans
- Department of Cardiology, CARIM, Maastricht University Medical Centre, 6229 ER Maastricht, The Netherlands
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
- Department of Cardiovascular Research, University of Leuven, 3000 Leuven, Belgium
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands
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Rubini A, Vilaplana-Prieto C, Vázquez-Jarén E, Hernández-González M, Félix-Redondo FJ, Fernández-Bergés D. Analysis and prediction of readmissions for heart failure in the first year after discharge with INCA score. Sci Rep 2023; 13:22477. [PMID: 38110472 PMCID: PMC10728208 DOI: 10.1038/s41598-023-49390-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023] Open
Abstract
To determine the readmissions trends and the comorbidities of patients with heart failure that most influence hospital readmission rates. Heart failure (HF) is one of the most prevalent health problems as it causes loss of quality of life and increased health-care costs. Its prevalence increases with age and is a major cause of re-hospitalisation within 30 days after discharge. INCA study had observational and ambispective design, including 4,959 patients from 2000 to 2019, with main diagnosis of HF in Extremadura (Spain). The variables examined were collected from discharge reports. To develop the readmission index, capable of discriminating the population with higher probability of re-hospitalisation, a Competing-risk model was generated. Readmission rate have increased over the period under investigation. The main predictors of readmission were: age, diabetes mellitus, presence of neoplasia, HF without previous hospitalisation, atrial fibrillation, anaemia, previous myocardial infarction, obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). These variables were assigned values with balanced weights, our INCA index showed that the population with values greater than 2 for men and women were more likely to be re-admitted. Previous HF without hospital admission, CKD, and COPD appear to have the greatest effect on readmission. Our index allowed us to identify patients with different risks of readmission.
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Affiliation(s)
- Alessia Rubini
- PhD Programme in Economics (DEcIDE), International Doctorate School of the National University of Distance Education (EIDUNED), 28015, Madrid, Spain.
- Research Unit of Don Benito-Villanueva de la Serena Health Area, 06700, Villanueva de la Serena, Spain.
| | | | - Elena Vázquez-Jarén
- Research Unit of Don Benito-Villanueva de la Serena Health Area, 06700, Villanueva de la Serena, Spain
- University Institute for Biosanitary Research of Extremadura (INUBE), 06080, Badajoz, Spain
| | - Miriam Hernández-González
- Research Unit of Don Benito-Villanueva de la Serena Health Area, 06700, Villanueva de la Serena, Spain
| | - Francisco Javier Félix-Redondo
- Research Unit of Don Benito-Villanueva de la Serena Health Area, 06700, Villanueva de la Serena, Spain
- University Institute for Biosanitary Research of Extremadura (INUBE), 06080, Badajoz, Spain
- Villanueva Norte Health Centre, Extremadura Health Service, 06700, Villanueva de la Serena, Spain
| | - Daniel Fernández-Bergés
- Research Unit of Don Benito-Villanueva de la Serena Health Area, 06700, Villanueva de la Serena, Spain
- University Institute for Biosanitary Research of Extremadura (INUBE), 06080, Badajoz, Spain
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Vázquez-Calatayud M, Olano-Lizarraga M, Quesada-Melero AM, Rumeu-Casares C, Saracíbar-Razquin M, Paloma-Mora B. Nursing capacity building in health coaching with hospitalised chronic heart failure patients: a quasi-experimental study. Contemp Nurse 2023; 59:443-461. [PMID: 37751247 DOI: 10.1080/10376178.2023.2262612] [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: 11/03/2022] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Difficulty in adherence to treatment and self-care behaviours is a leading cause of preventable readmission in people with chronic heart failure (CHF). Although there is evidence of benefits of health coaching for the management of this situation, few interventions have been tested in the hospital setting. AIM To evaluate a coaching programme (H-Coaching) designed to develop nursing capacity in health coaching for chronic heart failure inpatients. METHODS A quasi-experimental pre-post study including all nurses in a single centre cardiology ward (N = 19). The intervention consisted of two training packages: (1) five theoretical-practical sessions on health-coaching competencies, emotional intelligence, communication and support of chronic heart failure patients in their illness in the hospital setting; and (2) training sessions seven months after the first training package to reinforce the theoretical and practical knowledge. On four occasions, the Competence Instrument of Health Education for the Nursing professional was used to measure nurses' knowledge, skills and attitudes in health coaching for chronic heart failure patients. RESULTS The difference between the preintervention and postintervention scores were statistically significant for knowledge [mean difference = 1.00 (95% CI -1.45 to -0.51; p = 0.000)], skills in general [mean difference = 0.50 (95% CI -1.41 to -0.21; p = 0.015)] and personal/social skills [mean difference = 1.00 (95% CI -1.10 to -0.01; p = 0.048)]. While attitudinal and affective domains did not differ, there were differences in knowledge and skills. CONCLUSION The H-Coaching programme proved to be effective for building nursing capacity in health coaching CHF inpatients. Similar programmes designed to improve knowledge in verbal and nonverbal communication techniques, and skills for coaching interventions adapted to meet the needs of individual patients, should be tested in future interventional experimental studies. CLINICAL TRIAL REGISTRATION NUMBER NCT05300880. IMPACT STATEMENT To our knowledge, this is the first nursing training intervention in health coaching for chronic heart failure the inpatient setting. This study has demonstrate improvements in both the knowledge and personal and social skills of cardiology nurses with regard to the development of health coaching in a hospital setting. Given the study design, further research is warranted. PLAIN LANGUAGE SUMMARY Many patients with chronic heart failure have problems in adhering to the treatment and self-care behaviours and this is one of the main causes of preventable readmission. To promote self-care, patients need to be empowered to integrate these habits into their daily lives and we should implement innovative strategies to achieve this. Health coaching is an ideal alternative to this but very few nurses in the hospital cardiology setting are experienced in health coaching. Our study has shown preliminary results demonstrating that a structured theoretical and practical training programme for nurses can improve nurses' knowledge and skills in health coaching for inpatient patients with chronic heart failure. This study provides an opportunity for future research to demonstrate whether nurses with this training have a positive impact on the health outcomes of chronic heart failure patients and, more specifically, on their levels of self-care and empowerment.
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Affiliation(s)
- Mónica Vázquez-Calatayud
- Clínica Universidad de Navarra, Avda. Pío XII 36, 31008 Pamplona, Spain
- School of Nursing, Universidad de Navarra, Campus Universitario, 31008 Pamplona, Spain
- University of Navarra, Innovation for a Person-Centred Care Research Group (ICCP-UNAV), Pamplona, Spain
- Navarra's Health Research Institute (IdiSNA), Pamplona, Spain
| | - Maddi Olano-Lizarraga
- School of Nursing, Universidad de Navarra, Campus Universitario, 31008 Pamplona, Spain
- University of Navarra, Innovation for a Person-Centred Care Research Group (ICCP-UNAV), Pamplona, Spain
- Navarra's Health Research Institute (IdiSNA), Pamplona, Spain
| | | | - Carmen Rumeu-Casares
- Clínica Universidad de Navarra, Avda. Pío XII 36, 31008 Pamplona, Spain
- University of Navarra, Innovation for a Person-Centred Care Research Group (ICCP-UNAV), Pamplona, Spain
| | - Maribel Saracíbar-Razquin
- School of Nursing, Universidad de Navarra, Campus Universitario, 31008 Pamplona, Spain
- University of Navarra, Innovation for a Person-Centred Care Research Group (ICCP-UNAV), Pamplona, Spain
- Navarra's Health Research Institute (IdiSNA), Pamplona, Spain
| | - Beatriz Paloma-Mora
- Clínica Universidad de Navarra, Avda. Pío XII 36, 31008 Pamplona, Spain
- University of Navarra, Innovation for a Person-Centred Care Research Group (ICCP-UNAV), Pamplona, Spain
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López-Azor JC, Delgado JF, Vélez J, Rodríguez R, Solís J, Del Oro M, Ortega C, Salguero-Bodes R, Palacios B, Vicent L, Moreno G, Rosillo N, Varela L, Capel M, Arribas F, Bernal JL, Bueno H. Differences in clinical outcomes, health care resource utilization and costs in heart failure patients according to left ventricular ejection fraction. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:862-871. [PMID: 37331588 DOI: 10.1016/j.rec.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/15/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION AND OBJECTIVES The impact of left ventricular ejection fraction (LVEF) on health care resource utilization (HCRU) and cost in heart failure (HF) patients is not well known. We aimed to compare outcomes, HCRUs and costs according to LVEF groups. METHODS Retrospective, observational study of all patients with an emergency department (ED) visit or admission to a tertiary hospital in Spain 2018 with a primary HF diagnosis. We excluded patients with newly diagnosed heart failure. One-year clinical outcomes, costs and HCRUs were compared according to LVEF (reduced [HFrEF], mildly reduced [HFmrEF], and preserved [HFpEF]). RESULTS Among 1287 patients with a primary diagnosis of HF in the ED, 365 (28.4%) were discharged to home (ED group), and 919 (71.4%) were hospitalized (hospital group [HG]). In total, 190 patients (14.7%) had HFrEF, 146 (11.4%) HFmrEF, and 951 (73.9%) HFpEF. The mean age was 80.1±10.7 years; 57.1% were female. The median [interquartile range] of costs per patient/y was €1889 [259-6269] in the ED group and €5008 [2747-9589] in the HG (P <.001). Hospitalization rates were higher in patients with HFrEF in the ED group. The median costs of HFrEF per patient/y were higher in patients in both groups: €4763 [2076-17 155] vs €3900 [590-8013] for HFmrEF vs €3812 [259-5486] for HFpEF in the ED group, and €6321 [3335-796] vs €6170 [3189-10484] vs €4636 [2609-8977], respectively, in the hospital group (all P <.001). This difference was driven by the more frequent admission to intensive care units, and greater use of diagnostic and therapeutic tests among HFrEF patients. CONCLUSIONS In HF, LVEF significantly impacts costs and HCRU. Costs were higher in patients with HFrEF, especially those requiring hospitalization, than in those with HFpEF.
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Affiliation(s)
- Juan Carlos López-Azor
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Facultad de Medicina, Universidad Europea, Madrid, Spain
| | - Juan Francisco Delgado
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Jorge Vélez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Departamento de control de gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rocío Rodríguez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Departamento de control de gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jorge Solís
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Manuel Del Oro
- Departamento de control de gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carmen Ortega
- Departamento de control de gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rafael Salguero-Bodes
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | | | - Lourdes Vicent
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Guillermo Moreno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Nicolás Rosillo
- Departamento de Medicina Preventiva, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | | | | | - Fernando Arribas
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - José L Bernal
- Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Héctor Bueno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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8
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Peña-Longobardo LM, Oliva-Moreno J, Fernández-Rodriguez C. The effect of hepatitis C-associated premature deaths on labour productivity losses in Spain: a ten-year analysis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:1271-1283. [PMID: 36352296 PMCID: PMC9646468 DOI: 10.1007/s10198-022-01540-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
Hepatitis C virus (HCV) infection causes a substantial economic burden, not only in terms of healthcare costs, but also in labour productivity losses. The main objective of this study is to provide objective and comparable information about the trend in labour productivity losses caused by premature HCV-associated deaths in Spain in recent years (2009-2018). We used nationwide data from several official sources to create a simulation model based on the human capital approach and to estimate the flows in labour productivity losses due to deaths identified in the period considered. Based on a pessimistic scenario, the annual number of deaths due to HCV infections decreased by 19.7% between 2009 and 2018. The years of potential labour productive life lost (YPLPLL) decreased by 38.1%. That reduction led to a decrease in annual labour productivity losses from €236 million in 2009 to €156 million in 2018 (-33.8%). The aggregate HCV-related labour productivity losses between 2009 and 2018 ranged from €1742 million (optimistic scenario) to €1949 million (pessimistic scenario), with an intermediate estimation of €1846 million (moderately optimistic scenario). These results show a substantial reduction in annual deaths, working-age deaths, YPLPLL, and labour productivity losses associated with HCV infection over this period.
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Affiliation(s)
- L M Peña-Longobardo
- Department of Economic Analysis and Finance and Seminar on Economics and Health, Universidad de Castilla-La Mancha, Toledo, Spain
| | - J Oliva-Moreno
- Department of Economic Analysis and Finance and Seminar on Economics and Health, Universidad de Castilla-La Mancha, Toledo, Spain.
| | - C Fernández-Rodriguez
- Service of Gastroenterology, Fundación Alcorcón University Hospital, University Rey Juan Carlos, Madrid, Spain
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9
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Capdevila Aguilera C, Vela Vallespín E, Clèries Escayola M, Yun Viladomat S, Fernández Solana C, Alcober Morte L, Monterde Prat D, Hidalgo Quirós E, Calero Molina E, José Bazán N, Moliner Borja P, Piera Jiménez J, Ruiz Muñoz M, Corbella Virós X, Jiménez-Marrero S, Garay Melero A, Ramos Polo R, Alcoberro Torres L, Pons Riverola A, Enjuanes Grau C, Comín-Colet J. Population-based evaluation of the impact of socioeconomic status on clinical outcomes in patients with heart failure in integrated care settings. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:803-812. [PMID: 36963612 DOI: 10.1016/j.rec.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/07/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION AND OBJECTIVES Low socioeconomic status (SES) is associated with poor outcomes in patients with heart failure (HF). We aimed to examine the influence of SES on health outcomes after a quality of care improvement intervention for the management of HF integrating hospital and primary care resources in a health care area of 209 255 inhabitants. METHODS We conducted a population-based pragmatic evaluation of the implementation of an integrated HF program by conducting a natural experiment using health care data. We included all individuals consecutively admitted to hospital with at least one ICD-9-CM code for HF as the primary diagnosis and discharged alive in Catalonia between January 1, 2015 and December 31, 2019. We compared outcomes between patients exposed to the new HF program and those in the remaining health care areas, globally and stratified by SES. RESULTS A total of 77 554 patients were included in the study. Death occurred in 37 469 (48.3%), clinically-related hospitalization in 41 709 (53.8%) and HF readmission in 29 755 (38.4%). On multivariate analysis, low or very low SES was associated with an increased risk of all-cause death and clinically-related hospitalization (all Ps <.05). The multivariate models showed a significant reduction in the risk of all-cause death (HR, 0.812; 95%CI, 0.723-0.912), clinically-related hospitalization (HR, 0.886; 95%CI, 0.805-0.976) and HF hospitalization (HR, 0.838; 95%CI, 0.745-0.944) in patients exposed to the new HF program compared with patients exposed to the remaining health care areas and this effect was independent of SES. CONCLUSIONS An intensive transitional HF management program improved clinical outcomes, both overall and across SES strata.
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Affiliation(s)
- Cristina Capdevila Aguilera
- Departamento de Gerencia, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Departamento de Ciencias Clínicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, Spain
| | - Emili Vela Vallespín
- Unidad de Información y Conocimiento, Servicio Catalán de la Salud (CatSalut), Barcelona, Spain; Digitalización para la Sostenibilidad del Sistema Sanitario DS3-IDIBELL, Servicio Catalán de la Salud (CatSalut), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montse Clèries Escayola
- Unidad de Información y Conocimiento, Servicio Catalán de la Salud (CatSalut), Barcelona, Spain; Digitalización para la Sostenibilidad del Sistema Sanitario DS3-IDIBELL, Servicio Catalán de la Salud (CatSalut), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Yun Viladomat
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Medicina Interna, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Coral Fernández Solana
- Servicio de Atención Primaria, Delta del Llobregat e IDIAP, Barcelona, Spain; Servicio de Atención Primaria, Instituto Catalán de la Salud, Barcelona, Spain
| | - Laia Alcober Morte
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Atención Primaria, Delta del Llobregat e IDIAP, Barcelona, Spain; Servicio de Atención Primaria, Instituto Catalán de la Salud, Barcelona, Spain
| | - David Monterde Prat
- Digitalización para la Sostenibilidad del Sistema Sanitario DS3-IDIBELL, Servicio Catalán de la Salud (CatSalut), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Atención Primaria, Instituto Catalán de la Salud, Barcelona, Spain
| | - Encarna Hidalgo Quirós
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Atención Primaria, Delta del Llobregat e IDIAP, Barcelona, Spain; Servicio de Atención Primaria, Instituto Catalán de la Salud, Barcelona, Spain
| | - Esther Calero Molina
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria José Bazán
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Moliner Borja
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Piera Jiménez
- Digitalización para la Sostenibilidad del Sistema Sanitario DS3-IDIBELL, Servicio Catalán de la Salud (CatSalut), L'Hospitalet de Llobregat, Barcelona, Spain; Facultad de Informática, Multimedia y Telecomunicaciones, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Marta Ruiz Muñoz
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella Virós
- Grupo de investigación en Enfermedades Sistémicas, Vasculares y Envejecimiento (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Facultad de Medicina, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Santiago Jiménez-Marrero
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alberto Garay Melero
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Raúl Ramos Polo
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lidia Alcoberro Torres
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alexandra Pons Riverola
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Enjuanes Grau
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Josep Comín-Colet
- Departamento de Ciencias Clínicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, Spain; Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain.
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10
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Schoonvelde SAC, Wiethoff I, Hiligsmann M, Evers SMAA, Michels M. Quality of life and societal costs in hypertrophic cardiomyopathy: protocol of the AFFECT-HCM study. Neth Heart J 2023; 31:238-243. [PMID: 36645545 PMCID: PMC10188851 DOI: 10.1007/s12471-022-01753-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Ever since the first description of hypertrophic cardiomyopathy (HCM), the most common genetic cardiac disease, tremendous progress has been made in the evaluation and management of HCM patients, but little attention has been focused on the impact of HCM on societal costs and quality of life (QoL). AIMS This paper describes the study protocol for the AFFECT-HCM study into burden of disease (BoD), which aims to estimate health-related QoL and societal costs in HCM patients and genotype-positive phenotype-negative (G+/P-) relatives during a one-year follow-up study, and relate this to the phenotypical HCM expression. METHODS A total of 400 Dutch HCM patients and 100 G+/P- subjects will be followed for one year in a prospective, multi-centre, prevalence-based BoD study. Societal costs will be measured via a bottom-up approach using the cost questionnaires iMCQ and iPCQ. For QoL, the generic EQ-5D-5L and disease-specific Kansas City Cardiomyopathy Questionnaire will be used. QoL and societal costs will be compared with phenotype-specific HCM characteristics and other determinants to identify factors that influence BoD. Accelerometry will test the correlation between BoD and physical activity. CONCLUSION The AFFECT-HCM study will evaluate the BoD in HCM patients and G+/P- subjects to improve the understanding of the societal and economic impact of HCM.
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Affiliation(s)
- Stephan A C Schoonvelde
- Department of Cardiology, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - Isabell Wiethoff
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- 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
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre for Economic Evaluation and Machine Learning, Utrecht, The Netherlands
| | - Michelle Michels
- Department of Cardiology, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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11
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Aguilar-Rodríguez F, Pessacg Lemes M, Alonso Carrillo J, de Juan Bagudá J. [Impact of early follow-up from primary care on 30days readmission after heart failure hospitalization]. Semergen 2023; 49:101911. [PMID: 36638620 DOI: 10.1016/j.semerg.2022.101911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Reducing heart failure (HF) admissions is one of the main objectives in disease control, due to its impact on prognosis and costs. The transitional models at discharge are imposed as a strategy capable of reducing hospitalizations, most of them based on specific hospital units. We analyzed the impact of the primary care (PC) post-discharge follow-up. MATERIAL AND METHODS Retrospective observational study at the referral area of a tertiary hospital. Linear regression analysis was performed between early follow-up from the PC center after HF admission rate and the 30-day all-cause readmission rate throughout 2021. RESULTS The degree of follow-up from PC after hospital discharge for heart failure is associated with fewer 30-day readmissions for all causes (Pearson's R=0.53, P=.02); with a decrease of 20%, similar to that observed when it is performed from other care facilities and which is maintained when adjusting for the complexity of the patients. CONCLUSIONS PC heart failure post-discharge follow-up could be effective in reducing hospitalizations, and is complementary to that carried out by hospital units.
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Affiliation(s)
- F Aguilar-Rodríguez
- Servicio de Medicina Interna, Unidad de Insuficiencia Cardiaca, Hospital Universitario 12 de Octubre, Madrid, España.
| | - M Pessacg Lemes
- Medicina de Familia y Comunitaria, Centro de Salud San Andrés, Madrid, España
| | - J Alonso Carrillo
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - J de Juan Bagudá
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España; Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, España
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12
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Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res 2023; 118:3272-3287. [PMID: 35150240 DOI: 10.1093/cvr/cvac013] [Citation(s) in RCA: 716] [Impact Index Per Article: 716.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/08/2022] [Indexed: 01/25/2023] Open
Abstract
Heart Failure (HF) is a multi-faceted and life-threatening syndrome characterized by significant morbidity and mortality, poor functional capacity and quality of life, and high costs. HF affects more than 64 million people worldwide. Therefore, attempts to decrease its social and economic burden have become a major global public health priority. While the incidence of HF has stabilized and seems to be declining in industrialized countries, the prevalence is increasing due to the ageing of the population, improved treatment of and survival with ischaemic heart disease, and the availability of effective evidence-based therapies prolonging life in patients with HF. There are geographical variations in HF epidemiology. There is substantial lack of data from developing countries, where HF exhibits different features compared with that observed in the Western world. In this review, we provide a contemporary overview on the global burden of HF, providing updated estimates on prevalence, incidence, outcomes, and costs worldwide.
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Affiliation(s)
- Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Moritz Becher
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Giuseppe M C Rosano
- St George's Hospital Medical School, London, UK.,IRCCS San Raffaele Roma, Rome, Italy
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13
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Tratamiento a distancia de la insuficiencia cardiaca mediante el algoritmo HeartLogic. Registro RE-HEART. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Fernández-Bergés D, González-Fernández R, Félix-Redondo FJ, Arevalo Lorido J, Yeguas Rosa L, Hernández-González M, Rubini A, Galán Montejano M, Gamero MC, Lozano Mera L. [Clinical and prognostic profile evolution of patients discharged from hospital due to heart failure in the first two decades of the 21st century. The INCA-Ex Registry]. Aten Primaria 2022; 54:102357. [PMID: 35576889 PMCID: PMC9118354 DOI: 10.1016/j.aprim.2022.102357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/19/2022] Open
Abstract
AIM To study the evolution of the clinical profile of a population discharged with a main diagnosis of heart failure (HF) in the first two decades of the century and the predictive variables of mortality and readmission in the first year of discharge. DESIGN Observational, retrospective, longitudinal study. SITE: Don Benito Villanueva de la Serena Badajoz health area. PARTICIPANTS All patients discharged with a main diagnosis of HF between 2000 and 2019 in a general hospital complex were included. MAIN MEASUREMENTS Sociodemographic and clinical variables were collected, and a one-year follow-up; the result variable was a composite of mortality and/or readmission. RESULTS A total of 4107 discharges were included, mean age 77.1 (SD±10.5) years, 53.1% women. The number of admissions, age, history of neoplasms, stroke, kidney failure, and anemia increased, as did readmissions (P for trends <.001), while mortality remained constant. Predictive variables for readmission and/or death were HR (95%CI): age (per year) 1.04 (1.03-1.04), diabetes: 1.11 (1.01-1.24), previous HF 1.41 (1.28-1.57), composite variable myocardial infarction, stroke and/or peripheral artery disease 1.24 (1.11-1.38), chronic obstructive pulmonary disease (COPD) 1.29 (1.15-1.44), neoplasia 1.33 (1.16-1.53), anemia 1.63 (1.41-1.86), chronic kidney failure 1.42 (1.26-1.60). CONCLUSIONS In the last 20 years, admissions for heart failure, patient age, and comorbidity have increased. Predictive variables for mortality and/or readmission were age, diabetes, previous cardiovascular disease, neoplasms, COPD, kidney failure, and anemia; however, mortality at one year remained constant.
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Affiliation(s)
- Daniel Fernández-Bergés
- Unidad de Investigación, Área de Salud Don Benito-Villanueva, Servicio Extremeño de Salud, Villanueva de la Serena, Badajoz, España; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Badajoz, España.
| | - Reyes González-Fernández
- Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Badajoz, España; Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Badajoz, Badajoz, España
| | - Francisco Javier Félix-Redondo
- Unidad de Investigación, Área de Salud Don Benito-Villanueva, Servicio Extremeño de Salud, Villanueva de la Serena, Badajoz, España; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Badajoz, España; Centro de Salud Villanueva Norte, Villanueva de la Serena, Badajoz, España
| | - José Arevalo Lorido
- Servicio de Medicina Interna, Hospital Universitario de Badajoz, Badajoz, España
| | - Lorena Yeguas Rosa
- Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Badajoz, España
| | - Miriam Hernández-González
- Unidad de Investigación, Área de Salud Don Benito-Villanueva, Servicio Extremeño de Salud, Villanueva de la Serena, Badajoz, España; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Badajoz, España
| | - Alessia Rubini
- Unidad de Investigación, Área de Salud Don Benito-Villanueva, Servicio Extremeño de Salud, Villanueva de la Serena, Badajoz, España; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Badajoz, España
| | - Miguel Galán Montejano
- Departamento de Medicina Interna, Complejo Hospitalario Don Benito-Villanueva, Don Benito, Badajoz, España
| | | | - Luis Lozano Mera
- Unidad de Investigación, Área de Salud Don Benito-Villanueva, Servicio Extremeño de Salud, Villanueva de la Serena, Badajoz, España; Centro de Salud Mérida Urbano I, Mérida, Badajoz, España
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15
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Bueno H, Bernal JL, Jiménez-Jiménez V, Martín-Sánchez FJ, Rossello X, Moreno G, Goñi C, Gil V, Llorens P, Naranjo N, Jacob J, Herrero-Puente P, Garrote S, Silla-Castro JC, Pocock SJ, Miró Ò. The Clinical outcomes, healthcare resource utilization, and related costs (COHERENT) model. Application in heart failure patients. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:585-594. [PMID: 34688580 DOI: 10.1016/j.rec.2021.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Composite endpoints are widely used but have several limitations. The Clinical outcomes, healthcare resource utilization and related costs (COHERENT) model is a new approach for visually displaying and comparing composite endpoints including all their components (incidence, timing, duration) and related costs. We aimed to assess the validity of the COHERENT model in a patient cohort. METHODS A color graphic system displaying the percentage of patients in each clinical situation (vital status and location: at home, emergency department [ED] or hospital) and related costs at each time point during follow-up was created based on a list of mutually exclusive clinical situations coded in a hierarchical fashion. The system was tested in a cohort of 1126 patients with acute heart failure from 25 hospitals. The system calculated and displayed the time spent in each clinical situation and health care resource utilization-related costs over 30 days. RESULTS The model illustrated the times spent over 30 days (2.12% in ED, 23.6% in index hospitalization, 2.7% in readmissions, 65.5% alive at home, and 6.02% dead), showing significant differences between patient groups, hospitals, and health care systems. The tool calculated and displayed the daily and cumulative health care-related costs over time (total, €4 895 070; mean, €144.91 per patient/d). CONCLUSIONS The COHERENT model is a new, easy-to-interpret, visual display of composite endpoints, enabling comparisons between patient groups and cohorts, including related costs. The model may constitute a useful new approach for clinical trials or observational studies, and a tool for benchmarking, and value-based health care implementation.
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Affiliation(s)
- Héctor Bueno
- Grupo de Investigación Cardiovascular Multidisciplinaria Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - José L Bernal
- Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Víctor Jiménez-Jiménez
- Laboratorio de Mecanoadaptación y Biología de Caveolas, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Francisco Javier Martín-Sánchez
- Grupo de Investigación Cardiovascular Multidisciplinaria Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Xavier Rossello
- Grupo de Investigación Cardiovascular Multidisciplinaria Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servei de Cardiologia, Institut d'Investigació Sanitària Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Guillermo Moreno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Clara Goñi
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Víctor Gil
- Servei d'Urgències, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Alicante, Spain
| | - Nerea Naranjo
- Facultad de Ingeniería Biomédica, Universidad Politécnica de Madrid, Madrid, Spain
| | - Javier Jacob
- Servei d'Urgències, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pablo Herrero-Puente
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - Sergio Garrote
- Grupo de Investigación Cardiovascular Multidisciplinaria Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Juan Carlos Silla-Castro
- Unidad de Bioinformática, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Stuart J Pocock
- Grupo de Investigación Cardiovascular Multidisciplinaria Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Òscar Miró
- Servei d'Urgències, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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Gonzalez-Loyola FE, Muñoz MA, Navas E, Real J, Vinyoles E, Verdú-Rotellar JM. Burden of heart failure in primary healthcare. Aten Primaria 2022; 54:102413. [PMID: 35777242 PMCID: PMC9251565 DOI: 10.1016/j.aprim.2022.102413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/24/2022] [Accepted: 06/02/2022] [Indexed: 01/08/2023] Open
Abstract
Objectives To determine the epidemiology of heart failure registered in primary healthcare clinical records in Catalunya, Spain, between 2010 and 2014, focusing on incidence, mortality, and resource utilization. Design Retrospective observational cohort study. Setting Study was carried out in primary care setting. Participants and interventions Patients registered as presenting a new heart failure diagnosis. The inclusion period ran from 1st January 2010 to 31st December 2013, but patients were followed until 31st December 2013 in order to analyze mortality. Main measures Information came from electronic medical records. Results A total of 64 441 patients were registered with a new diagnosis of heart failure (2.76 new cases per 1000 persons-year). Among them, 85.8% were ≥65 years. The number of cases/1000 persons-year was higher in men in all age groups. Incidence ranged from 0.04 in women <45 years to 27.61 in the oldest group, and from 0.08 in men <45 years to 28.52 in the oldest group. Mortality occurred in 16 305 (25.3%) patients. Primary healthcare resource utilization increased after the occurrence of heart failure, especially the number of visits made by nurses to the patients’ homes. Conclusion Heart failure incidence increases with age, is greater in men, and remains stable. Mortality continues to be high in newly diagnosed patients in spite of the current improvements in treatment. Home visits represent the greatest cost for the management of this disease in primary care setting.
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Affiliation(s)
- Felipe-Estuardo Gonzalez-Loyola
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Departament de Pediatría, Obstetricia i Ginecología i Medicina Preventiva, Programa de Doctorat en Metodología de la Recerca BIomèdica, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Miguel-Angel Muñoz
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Elena Navas
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Jordi Real
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Ernest Vinyoles
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - José-Maria Verdú-Rotellar
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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Cerqueiro-González J, González-Franco Á, Carrascosa-García S, Soler-Rangel L, Ruiz-Laiglesia F, Epelde-Gonzalo F, Dávila-Ramos M, Casado-Cerrada J, Casariego-Vales E, Manzano L. Beneficios de un modelo asistencial integral en pacientes con insuficiencia cardíaca y fracción de eyección preservada: Programa UMIPIC. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Bundgaard JS, Mogensen UM, Christensen S, Ploug U, Rørth R, Ibsen R, Kjellberg J, Køber L. Healthcare cost variation in patients with heart failure: a nationwide study. Public Health 2022; 207:88-93. [PMID: 35594807 DOI: 10.1016/j.puhe.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/28/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Heart failure (HF) imposes a major economic burden; however, the individual management for patients varies, potentially leading to large cost heterogeneity. The aim of this study was to investigate the spectrum of health cost by patients with HF and factors associated with high direct health cost. STUDY DESIGN This was a nationwide, retrospective longitudinal study. METHODS Using Danish nationwide registries from 2012 to 2015, we identified all patients aged >18 years with a first-time diagnosis of HF. Total health costs were investigated using two perspectives-at index and during 3 years of follow-up. Patients were investigated by decile cost groups. A multivariable logistic regression was used to identify variables associated with being in the highest cost decile compared with the rest (90%). RESULTS A total of 11,170 patients with HF were included, and those in the highest cost decile (n = 1117, 10%) were younger (69 vs. 75 years), fewer were females (34% vs. 43%), and more were inpatients (83% vs. 70%) compared with the rest of the patients with HF (n = 10,053, 90%). Patients in the highest cost decile (10%) incurred a 30 times higher cost with a mean total health cost in index year of €86,607 compared with €2893 for patients in lowest cost decile (10%). The results were similar for 3 years aggregated (€139,473 vs. €4086), corresponding to a 34 times higher cost. CONCLUSION In patients with HF, a large total health cost heterogeneity exists with younger age, inpatient admittance, male sex, and comorbidities being associated with a higher likelihood of belonging to the highest cost group.
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Affiliation(s)
- J Skov Bundgaard
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark.
| | - U M Mogensen
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark
| | | | | | - R Rørth
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark
| | | | - J Kjellberg
- Danish Institute for Health Services Research, Copenhagen, Denmark
| | - L Køber
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark
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Delgado JF, Bueno H. ¿Podemos mejorar la atención a la insuficiencia cardiaca en España? Med Clin (Barc) 2022; 159:90-91. [DOI: 10.1016/j.medcli.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
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Pinar E, García de Lara J, Hurtado J, Robles M, Leithold G, Martí-Sánchez B, Cuervo J, Pascual DA, Estévez-Carrillo A, Crespo C. Análisis coste-efectividad del implante percutáneo de válvula aórtica SAPIEN 3 en pacientes con estenosis aórtica grave sintomática. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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21
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González-Franco Á, Cerqueiro González J, Arévalo-Lorido J, Álvarez-Rocha P, Carrascosa-García S, Armengou A, Guzmán-García M, Trullàs J, Montero-Pérez-Barquero M, Manzano L. Beneficios de un modelo asistencial integral en pacientes ancianos con insuficiencia cardíaca y elevada comorbilidad: programa UMIPIC. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Almenar Bonet L, Blasco Peiró MT, Laiz Marro B, Camafort Babkowski M, Buño Soto A, Crespo-Leiro MG. Specific test panels for patients with heart failure: implementation and use in the Spanish National Health System. ADVANCES IN LABORATORY MEDICINE 2022; 3:65-78. [PMID: 37359437 PMCID: PMC10197348 DOI: 10.1515/almed-2022-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/17/2021] [Indexed: 06/28/2023]
Abstract
Objectives The use of specific test panels (STP) for heart failure (HF) could help improve the management of this condition. The purpose of this study is to gain an insight into the level of implementation of STPs in the management of HF in Spain and gather the opinions of experts, with a special focus on parameters related to iron metabolism. Methods The opinions of experts in HF were gathered in three stages STAGE 1 as follows: level of implementation of STPs (n=40). STAGE 2: advantages and disadvantages of STPs (n=12). STAGE 3: level of agreement with the composition of three specific STPs for HF: initial evaluation panel, monitoring panel, and de novo panel (n=16). Results In total, 62.5% of hospitals used STPs for the clinical management of HF, with no association found between the use of STPs and the level of health care (p=0.132) and location of the center (p=0.486) or the availability of a Heart Failure Unit in the center (p=0.737). According to experts, the use of STPs in clinical practice has more advantages than disadvantages (8 vs. 3), with a notable positive impact on diagnostics. Experts gave three motivations and found three limitations to the implementation of STPs. The composition of the three specific STPs for HF was viewed positively by experts. Conclusions Although the experts interviewed advocate the use of diagnostic and monitoring STPs for HF, efforts are still necessary to achieve the standardization and homogenization of test panels for HF in Spanish hospitals.
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Affiliation(s)
- Luis Almenar Bonet
- Unit of Heart Failure and Transplant, Service of Cardiology, University and Polytechnic La Fe Hospital of Valencia, Valencia, Spain
- University of Valencia, Valencia, Spain
- Spanish Network-Center for Cardiovascular Biomedical Research (CIBERCV), Madrid, Spain
| | - Mᵃ Teresa Blasco Peiró
- Unit of Heart Failure and Transplant, Service of Cardiology, Miguel Servet University Hospital, Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
| | - Begoña Laiz Marro
- Laboratory Analysis Service, University and Polytechnic La Fe Hospital of Valencia, Valencia, Spain
| | - Miguel Camafort Babkowski
- Service of Internal Medicine, ICMiD, Hospital Clínic, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Antonio Buño Soto
- Laboratory Analysis Service, La Paz University Hospital, Madrid, Spain
| | - Maria Generosa Crespo-Leiro
- Unit of Heart Failure and Heart Transplant, Service of Cardiology, A Coruña Hospital Complex, CHUAC, A Coruña (UDC), Spain
- Biomedical Research Institute of A Coruña (INIBIC), A Coruña, Spain
- University of A Coruña, A Coruña, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Cerqueiro-González J, González-Franco Á, Carrascosa-García S, Soler-Rangel L, Ruiz-Laiglesia F, Epelde-Gonzalo F, Dávila-Ramos M, Casado-Cerrada J, Casariego-Vales E, Manzano L. Benefits of a comprehensive care model in patients with heart failure and preserved ejection fraction: The UMIPIC program. Rev Clin Esp 2022; 222:339-347. [DOI: 10.1016/j.rceng.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/14/2021] [Indexed: 01/10/2023]
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López-Azor JC, de la Torre N, García-Cosío Carmena MD, Caravaca Pérez P, Munera C, MarcoClement I, Cózar León R, Álvarez-García J, Pachón M, Ynsaurriaga FA, Salguero Bodes R, Delgado Jiménez JF, de Juan Bagudá J. Clinical Utility of HeartLogic, a Multiparametric Telemonitoring System, in Heart Failure. Card Fail Rev 2022; 8:e13. [PMID: 35516795 PMCID: PMC9062709 DOI: 10.15420/cfr.2021.35] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/08/2022] [Indexed: 01/09/2023] Open
Abstract
Telemonitoring through multiple variables measured on cardiac devices has the potential to improve the follow-up of patients with heart failure. The HeartLogic algorithm (Boston Scientific), implemented in some implantable cardiac defibrillators and cardiac resynchronisation therapy, allows monitoring of the nocturnal heart rate, respiratory movements, thoracic impedance, physical activity and the intensity of heart tones, with the aim of predicting major clinical events. Although HeartLogic has demonstrated high sensitivity for the detection of heart failure decompensations, its effects on hospitalisation and mortality in randomised clinical trials has not yet been corroborated. This review details how the HeartLogic algorithm works, compiles available evidence from clinical studies, and discusses its application in daily clinical practice.
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Affiliation(s)
- Juan Carlos López-Azor
- Cardiology Service, Hospital Universitario 12 de OctubreMadrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Madrid, Spain
| | | | - María Dolores García-Cosío Carmena
- Cardiology Service, Hospital Universitario 12 de OctubreMadrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Madrid, Spain
| | - Pedro Caravaca Pérez
- Cardiology Service, Hospital Universitario 12 de OctubreMadrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Madrid, Spain
| | - Catalina Munera
- Cardiology Service, Hospital Universitario 12 de OctubreMadrid, Spain
| | - Irene MarcoClement
- Cardiology Service, Hospital Universitario 12 de OctubreMadrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Madrid, Spain
| | - Rocío Cózar León
- Cardiology Service, University Hospital Virgen MacarenaSeville, Spain
| | - Jesús Álvarez-García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Madrid, Spain
- Cardiology Service, University Hospital Ramón y CajalMadrid, Spain
| | - Marta Pachón
- Cardiology Service, Unidad de Arritmias, Hospital Universitario de ToledoToledo, Spain
| | - Fernando Arribas Ynsaurriaga
- Cardiology Service, Hospital Universitario 12 de OctubreMadrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Madrid, Spain
| | - Rafael Salguero Bodes
- Cardiology Service, Hospital Universitario 12 de OctubreMadrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Madrid, Spain
| | - Juan Francisco Delgado Jiménez
- Cardiology Service, Hospital Universitario 12 de OctubreMadrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Madrid, Spain
- Faculty of Medicine, Complutense UniversityMadrid, Spain
| | - Javier de Juan Bagudá
- Cardiology Service, Hospital Universitario 12 de OctubreMadrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Madrid, Spain
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[SEMERGEN positioning on approaching chronic heart failure in primary care]. Semergen 2021; 48:106-123. [PMID: 34924298 DOI: 10.1016/j.semerg.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) is a public health problem that generates a large healthcare burden both in hospitals and in Primary Care (PC). The publication of numerous studies about HF in recent years has led to a paradigm shift in the approach to this syndrome, in which the work of PC teams is gaining greater prominence. The recent guidelines published by the European Society of Cardiology have fundamentally introduced changes in the management of patients with HF. The new proposed strategy, with drugs that reduce hospitalizations and slow the progression of the disease, should now be a priority for all professionals involved. This position document analyzes a proposal for an approach based on multidisciplinary teams with the leadership of family doctors, key to providing quality care throughout the entire process of the disease, from its prevention to the end of the life.
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Reducing the Heart Failure Burden in Romania by Predicting Congestive Heart Failure Using Artificial Intelligence: Proof of Concept. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112411728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Due to population aging, we are currently confronted with an increased number of chronic heart failure patients. The primary purpose of this study was to implement a noncontact system that can predict heart failure exacerbation through vocal analysis. We designed the system to evaluate the voice characteristics of every patient, and we used the identified variations as an input for a machine-learning-based approach. We collected data from a total of 16 patients, 9 men and 7 women, aged 65–91 years old, who agreed to take part in the study, with a detailed signed informed consent. We included hospitalized patients admitted with cardiogenic acute pulmonary edema in the study, regardless of the precipitation cause or other known cardiovascular comorbidities. There were no specific exclusion criteria, except age (which had to be over 18 years old) and patients with speech inabilities. We then recorded each patient’s voice twice a day, using the same smartphone, Lenovo P780, from day one of hospitalization—when their general status was critical—until the day of discharge, when they were clinically stable. We used the New York Heart Association Functional Classification (NYHA) classification system for heart failure to include the patients in stages based on their clinical evolution. Each voice recording has been accordingly equated and subsequently introduced into the machine-learning algorithm. We used multiple machine-learning techniques for classification in order to detect which one turns out to be more appropriate for the given dataset and the one that can be the starting point for future developments. We used algorithms such as Artificial Neural Networks (ANN), Support Vector Machine (SVM) and K-Nearest Neighbors (KNN). After integrating the information from 15 patients, the algorithm correctly classified the 16th patient into the third NYHA stage at hospitalization and second NYHA stage at discharge, based only on his voice recording. The KNN algorithm proved to have the best classification accuracy, with a value of 0.945. Voice is a cheap and easy way to monitor a patient’s health status. The algorithm we have used for analyzing the voice provides highly accurate preliminary results. We aim to obtain larger datasets and compute more complex voice analyzer algorithms to certify the outcomes presented.
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Remote heart failure management using the HeartLogic algorithm. RE-HEART Registry. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 75:709-716. [PMID: 34896031 DOI: 10.1016/j.rec.2021.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/14/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES HeartLogic is a multiparametric algorithm incorporated into implantable cardioverter-defibrillators (ICD). The associated alerts predict impending heart failure (HF) decompensations. Our objective was to analyze the association between alerts and clinical events and to describe the implementation of a protocol for remote management in a multicenter registry. METHODS We evaluated study phase 1 (the investigators were blinded to the alert state) and phases 2 and 3 (after HeartLogic activation, managed as per local practice and with a standardized protocol, respectively). RESULTS We included 288 patients from 15 centers. In phase 1, the median observation period was 10 months and there were 73 alerts (0.72 alerts/patient-y), with 8 hospitalizations and 2 emergency room admissions for HF (0.10 events/patient-y). There were no HF hospitalizations outside the alert period. In the active phases, the median follow-up was 16 (95%CI, 15-22) months and there were 277 alerts (0.89 alerts/patient-y); 33 were associated with HF hospitalizations or HF death (n=6), 46 with minor decompensations, and 78 with other events. The unexplained alert rate was 0.39 alerts/patient-y. Outside the alert state, there was only 1 HF hospitalization and 1 minor HF decompensation. Most alerts (82% in phase 2 and 81% in phase 3; P=.861) were remotely managed. The median NT-proBNP value was higher within than outside the alert state (7378 vs 1210 pg/mL; P <.001). CONCLUSIONS The HeartLogic index was frequently associated with HF-related events and other clinically relevant situations, with a low rate of unexplained events. A standardized protocol allowed alerts to be safely and remotely detected and appropriate action to be taken on them.
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Bueno H, Bernal JL, Jiménez-Jiménez V, Martín-Sánchez FJ, Rossello X, Moreno G, Goñi C, Gil V, Llorens P, Naranjo N, Jacob J, Herrero-Puente P, Garrote S, Silla-Castro JC, Pocock SJ, Miró Ò. El modelo Clinical outcomes, healthcare resource utilization, and related costs (COHERENT). Aplicación en pacientes con insuficiencia cardiaca. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bonilla-Palomas JL, Anguita-Sánchez MP, Elola-Somoza FJ, Bernal-Sobrino JL, Fernández-Pérez C, Ruiz-Ortíz M, Jiménez-Navarro M, Bueno-Zamora H, Cequier-Fillat Á, Marín-Ortuño F. Thirteen-year trends in hospitalization and outcomes of patients with heart failure in Spain. Eur J Clin Invest 2021; 51:e13606. [PMID: 34076253 DOI: 10.1111/eci.13606] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/06/2021] [Accepted: 05/14/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Heart failure is one of the most pressing current public health concerns. However, in Spain there is a lack of population data. We aimed to examine thirteen-year nationwide trends in heart failure hospitalization, in-hospital mortality and 30-day readmission rates in Spain. METHODS We conducted a retrospective observational study of patients discharged with the principal diagnosis of heart failure from The National Health System' acute hospitals during 2003-2015. The source of the data was the Minimum Basic Data Set. Temporal trends were modelled using Poisson regression analysis. The risk-standardized in-hospital mortality ratio was calculated using a multilevel risk adjustment logistic regression model. RESULTS A total of 1 254 830 episodes of heart failure were selected. Throughout 2003-2015, the number of hospital discharges with principal diagnosis of heart failure increased by 61%. Discharge rates weighted by age and sex increased during the period [incidence rate ratio (IRR): 1.03; 95% confidence interval (95% CI): 1.03-1.03; P < .001)], although this increase was motivated by the increase in older age groups (≥75 years old). The crude mortality rate diminished (IRR: 0.99; 95% CI: 0.98-1, P < .001), but 30-day readmission rate increased (IRR: 1.05; 95% CI: 1.04-1.06; P < .001). The risk-standardized in-hospital mortality ratio did not change throughout the study period (IRR: 0.997; 95% CI: 0.992-1; P = .32). CONCLUSIONS From 2003 to 2015, heart failure admission rates increased significantly in Spain as a consequence of the sustained increase of hospitalization in the population ≥75 years. 30-day readmission rates increased, but the risk-standardized in-hospital mortality ratio did not significantly change for the same period.
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Affiliation(s)
| | | | | | - José L Bernal-Sobrino
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain.,Servicio de Control de Gestión, University Hospital 12 de Octubre, Madrid, Spain
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Liao CT, Yang CT, Toh HS, Chang WT, Chang HY, Kuo FH, Lee MC, Hua YM, Tang HJ, Strong C, Ou HT. Cost-effectiveness evaluation of add-on dapagliflozin for heart failure with reduced ejection fraction from perspective of healthcare systems in Asia-Pacific region. Cardiovasc Diabetol 2021; 20:204. [PMID: 34627231 PMCID: PMC8502298 DOI: 10.1186/s12933-021-01387-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/20/2021] [Indexed: 12/28/2022] Open
Abstract
Background With emerging evidence on the efficacy of adding dapagliflozin to standard care for patients with heart failure with reduced ejection fraction (HFrEF), this study assessed the cost-effectiveness of add-on dapagliflozin to standard care versus standard care alone for HFrEF from the perspective of healthcare systems in the Asia–Pacific region. Methods A Markov model was applied to project the outcomes of treatment in terms of lifetime medical cost and quality-adjusted life-years. The transition probabilities between health states in the model were obtained from the Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction trial. Country-specific costs and utilities were extracted for modeling. The incremental cost-effectiveness ratio against a country-specific willingness-to-pay threshold was applied to determine the cost-effectiveness of treatment. A series of sensitivity analyses were performed to ensure the robustness of the study results. Costs are presented in 2020 United States dollars. Results The incremental cost-effectiveness ratios for add-on dapagliflozin versus standard care alone were $5277, $9980, $12,305, $16,705, and $23,227 per quality-adjusted life-year gained in Korea, Australia, Taiwan, Japan, and Singapore, respectively. When using add-on dapagliflozin to standard care versus standard care alone, ~ 100% of simulations were cost-effective at a willingness-to-pay threshold of one gross domestic product per capita of the given Asia–Pacific country; however, the probability of being cost-effective for using add-on dapagliflozin decreased when the time horizon for simulation was restricted to 18 months and when the cardiovascular mortality for the two treatments (43.8% and 33.0%, respectively) was assumed to be the same. The cost-effectiveness results were most sensitive to cardiovascular mortality of treatment. Conclusions Adding dapagliflozin to standard care is cost-effective for HFrEF in healthcare systems in the Asia–Pacific region, which supports the rational use of dapagliflozin for HFrEF in this region. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01387-3.
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Affiliation(s)
- Chia-Te Liao
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chun-Ting Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Han Siong Toh
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Health and Nutrition, Chia Nan University of Pharmacy & Science, Tainan, Taiwan
| | - Wei-Ting Chang
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Hung-Yu Chang
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fang-Hsiu Kuo
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Mei-Chuan Lee
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan
| | - Yi-Ming Hua
- Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsin-Ju Tang
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Carol Strong
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huang-Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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González-Franco Á, Cerqueiro González JM, Arévalo-Lorido JC, Álvarez-Rocha P, Carrascosa-García S, Armengou A, Guzmán-García M, Trullàs JC, Montero-Pérez-Barquero M, Manzano L. Morbidity and mortality in elderly patients with heart failure managed with a comprehensive care model vs. usual care: The UMIPIC program. Rev Clin Esp 2021; 222:123-130. [PMID: 34615617 DOI: 10.1016/j.rceng.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Elderly patients with heart failure (HF) have a high degree of comorbidity which leads to fragmented care, with frequent hospitalizations and high mortality. This study evaluated the benefit of a comprehensive continuous care model (UMIPIC program) in elderly HF patients. METHODS AND RESULTS We prospectively analyzed data from the RICA registry on 2862 patients with HF treated in internal medicine departments. They were divided into two groups: one monitored in the UMIPIC program (UMIPIC group, n: 809) and another which received conventional care (RICA group, n: 2.053). We evaluated HF readmissions during 12 months of follow-up and total mortality after episodes of HF hospitalization. UMIPIC patients were older with higher rates of comorbidity and preserved ejection fraction than the RICA group. However, the UMIPIC group had a lower rate of HF readmissions (17% vs. 26%, p < .001) and mortality (16% vs. 27%, respectively; p < .001). In addition, we selected 370 propensity score-matched patients from each group and the differences in HF readmissions (15% UMIPIC vs. 30% RICA; hazard ratio [HR] = 0.44; 95% confidence interval [CI] 0.32-0.60; p < .001) and mortality (17% UMIPIC vs. 28% RICA; hazard ratio = 0.58; 95% CI 0.42-0.79; p = .001) were maintained. CONCLUSIONS The implementation of the UMIPIC program, based on comprehensive continuous care of elderly patients with HF and high comorbidity, markedly reduce HF readmissions and total mortality.
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Affiliation(s)
- Á González-Franco
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | | | - J C Arévalo-Lorido
- Servicio de Medicina Interna, Hospital Comarcal de Zafra, Zafra, Badajoz, Spain
| | - P Álvarez-Rocha
- Servicio de Medicina Interna y Cardiología, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
| | - S Carrascosa-García
- Servicio de Medicina Interna, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - A Armengou
- Servicio de Medicina Interna, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - M Guzmán-García
- Servicio de Medicina Interna, Hospital San Juan de la Cruz, Jaén, Spain
| | - J C Trullàs
- Servicio de Medicina Interna, Hospital d'Olot i comarcal de la Garrotxa, Girona, Spain; Laboratori de Reparació i Regeneració Tissular (TR2Lab), Facultat de Medicina, Universitat de Vic - Universitat Central de Catalunya, Vic, Barcelona, Spain
| | - M Montero-Pérez-Barquero
- Servicio de Medicina Interna, IMIBIC/Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, Spain
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Alghamdi A, Algarni E, Balkhi B, Altowaijri A, Alhossan A. Healthcare Expenditures Associated with Heart Failure in Saudi Arabia: A Cost of Illness Study. Healthcare (Basel) 2021; 9:healthcare9080988. [PMID: 34442125 PMCID: PMC8391138 DOI: 10.3390/healthcare9080988] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 11/16/2022] Open
Abstract
Heart failure (HF) is considered to be a global health problem that generates a significant economic burden. Despite the growing prevalence in Saudi Arabia, the economic burden of HF is not well studied. The aim of this study was to estimate the health care expenditures associated with HF in Saudi Arabia from a social perspective. We conducted a multicenter cost of illness (COI) study in two large governmental centers in Riyadh, Saudi Arabia using 369 HF patients. A COI model was developed in order to estimate the direct medical costs associated with HF. The indirect costs of HF were estimated based on a human capital approach. Descriptive and inferential statistics were analyzed. The direct medical cost per HF patient was $9563. Hospitalization costs were the major driver in total spending, followed by medication and diagnostics costs. The cost significantly increased in line with the disease progression, ranging from $3671 in class I to $16,447 in class IV. The indirect costs per working HF patient were $4628 due to absenteeism, and $6388 due to presenteeism. The economic burden of HF is significantly high in Saudi Arabia. Decision makers need to focus on allocating resources towards strategies that prevent frequent hospitalizations and improve HF management and patient outcomes in order to lower the growing economic burden.
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Affiliation(s)
- Ahmed Alghamdi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (B.B.); (A.A.)
- Correspondence: ; Tel.: +966-114-677-479
| | - Eman Algarni
- Prince Sultan Cardiac Center, Prince Sultan Military Medical City, Riyadh 12233, Saudi Arabia;
| | - Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (B.B.); (A.A.)
| | - Abdulaziz Altowaijri
- Program for Health Assurance and Purchasing, Vision Realization Office, Ministry of Health, Riyadh 13315, Saudi Arabia;
| | - Abdulaziz Alhossan
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (B.B.); (A.A.)
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Levy AR, Johnston KM, Daoust A, Ignaszewski A, Fortier J, Rogula B, Oh P. Health expenditures after first hospital admission for heart failure in Nova Scotia, Canada: a retrospective cohort study. CMAJ Open 2021; 9:E826-E833. [PMID: 34446462 PMCID: PMC8412419 DOI: 10.9778/cmajo.20200230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although the frequency of heart failure makes it among the costliest of illnesses, there are scant Canadian data on annual costs of treatment or the costs as the condition advances. Our objective was to estimate mean prevalence- and incidence-based direct medical costs among older adults discharged alive after a first hospital admission for heart failure. METHODS We conducted a retrospective cohort study using population-based administrative health databases for Nova Scotia. The cohort comprised persons 50 years of age or older with an incident hospital admission for heart failure between 2009 and 2012. We considered the costs (expressed as 2020 Canadian dollars) of hospital admissions, physician visits and, for patients 65 years of age or older, outpatient cardiac medications. We estimated costs for calendar years, longitudinally and in the last 2 years of life. We analyzed costs from the perspective of a third-party public payer. RESULTS The cohort consisted of 3327 patients (mean age 77.6 yr; 1605 [48.2%] women). Median survival was 2.5 and 2.2 years among men and women, respectively. Annual prevalence-based costs were about $7100. Mean incidence-based costs ranged between $65 000 and $164 000 in the year after diagnosis and decreased by 90% subsequently. Costs were 4 to 7 times higher in the year before death than in the period from 1 to 2 years before death. INTERPRETATION The direct medical costs of treating patients with heart failure in Nova Scotia displayed a reverse J shape, with costs highest after diagnosis, declining subsequently and then increasing during the final year of life. Strategies designed to improve the quality of care immediately after diagnosis and during more advanced stages of disease might reduce these costs.
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Affiliation(s)
- Adrian R Levy
- Department of Community Health and Epidemiology (Levy), Faculty of Medicine, Dalhousie University, Halifax, NS; Broadstreet Health Economics & Outcomes Research (Johnston, Rogula) and Division of Cardiology (Ignaszewski), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Novartis Pharmaceuticals Canada Inc. (Daoust, Fortier), Dorval, Que.; Toronto Rehabilitation Institute (Oh), Toronto, Ont.
| | - Karissa M Johnston
- Department of Community Health and Epidemiology (Levy), Faculty of Medicine, Dalhousie University, Halifax, NS; Broadstreet Health Economics & Outcomes Research (Johnston, Rogula) and Division of Cardiology (Ignaszewski), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Novartis Pharmaceuticals Canada Inc. (Daoust, Fortier), Dorval, Que.; Toronto Rehabilitation Institute (Oh), Toronto, Ont
| | - Alexia Daoust
- Department of Community Health and Epidemiology (Levy), Faculty of Medicine, Dalhousie University, Halifax, NS; Broadstreet Health Economics & Outcomes Research (Johnston, Rogula) and Division of Cardiology (Ignaszewski), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Novartis Pharmaceuticals Canada Inc. (Daoust, Fortier), Dorval, Que.; Toronto Rehabilitation Institute (Oh), Toronto, Ont
| | - Andrew Ignaszewski
- Department of Community Health and Epidemiology (Levy), Faculty of Medicine, Dalhousie University, Halifax, NS; Broadstreet Health Economics & Outcomes Research (Johnston, Rogula) and Division of Cardiology (Ignaszewski), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Novartis Pharmaceuticals Canada Inc. (Daoust, Fortier), Dorval, Que.; Toronto Rehabilitation Institute (Oh), Toronto, Ont
| | - Jonathan Fortier
- Department of Community Health and Epidemiology (Levy), Faculty of Medicine, Dalhousie University, Halifax, NS; Broadstreet Health Economics & Outcomes Research (Johnston, Rogula) and Division of Cardiology (Ignaszewski), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Novartis Pharmaceuticals Canada Inc. (Daoust, Fortier), Dorval, Que.; Toronto Rehabilitation Institute (Oh), Toronto, Ont
| | - Basia Rogula
- Department of Community Health and Epidemiology (Levy), Faculty of Medicine, Dalhousie University, Halifax, NS; Broadstreet Health Economics & Outcomes Research (Johnston, Rogula) and Division of Cardiology (Ignaszewski), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Novartis Pharmaceuticals Canada Inc. (Daoust, Fortier), Dorval, Que.; Toronto Rehabilitation Institute (Oh), Toronto, Ont
| | - Paul Oh
- Department of Community Health and Epidemiology (Levy), Faculty of Medicine, Dalhousie University, Halifax, NS; Broadstreet Health Economics & Outcomes Research (Johnston, Rogula) and Division of Cardiology (Ignaszewski), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Novartis Pharmaceuticals Canada Inc. (Daoust, Fortier), Dorval, Que.; Toronto Rehabilitation Institute (Oh), Toronto, Ont
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Formiga F, García-Pavía P, Martín Sánchez FJ, Navarro-Ruiz A, Rubio-Terrés C, Peral C, Tarilonte P, López-Ibáñez de Aldecoa A, Rubio-Rodríguez D. Health and economic impact of the correct diagnosis of transthyretin cardiac amyloidosis in Spain. Expert Rev Pharmacoecon Outcomes Res 2021; 21:1127-1133. [PMID: 34047214 DOI: 10.1080/14737167.2021.1933948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To estimate the health and economic impact of the reduction in mortality and cardiovascular hospitalizations, associated with correct diagnosis of cardiac transthyretin amyloidosis (ATTR-CM), from the Spanish National Health System (NHS) perspective.Methods: A costs and effects analysis were performed (probabilistic Markov model) with time horizons between 1 and 15 years, comparing the correct diagnosis of ATTR-CM versus the non-diagnosis. Transition probabilities were obtained from the ATTR-ACT study (placebo arm) and from the literature. Costs and healthcare resources were obtained from Spanish sources (€ 2019) and from a panel of Spanish clinical experts.Results: After 1, 5, 10 and 15 years, the diagnosis of ATTR-CM would generate a gain of 0.031 (95%CI 0.025; 0.038); 0.387 (95%CI 0.329; 0.435); 0.754 (95%CI 0.678; 0.781) and 0.944 (95%CI 0.905; 0.983) life years per patient, respectively, with savings of € 212 (95%CI € -632; 633), € 2,289 (95%CI € 2,250; 2,517), € 2,859 (95%CI € 2,584; 3,149) and € 2,906 (95%CI € 2,669; 3,450) per patient, respectively, versus the non-diagnosis.Conclusions: Just by correctly diagnosing ATTR-CM, years of life would be gained, cardiovascular hospitalizations would be avoided, and savings would be generated for the NHS, compared to the non-diagnosis of the disease.
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Affiliation(s)
- Francesc Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - Pablo García-Pavía
- Heart Failure and Family Heart Disease Unit, Cardiology Department, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain
| | | | - Andrés Navarro-Ruiz
- Pharmacy Department, Hospital General Universitario de Elche , Alicante, Spain
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No inferioridad de la titulación de enfermera de insuficiencia cardiaca en comparación con la de cardiólogo de insuficiencia cardiaca. Ensayo aleatorizado multicéntrico ETIFIC. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.04.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Pinar E, García de Lara J, Hurtado J, Robles M, Leithold G, Martí-Sánchez B, Cuervo J, Pascual DA, Estévez-Carrillo A, Crespo C. Cost-effectiveness analysis of the SAPIEN 3 transcatheter aortic valve implant in patients with symptomatic severe aortic stenosis. ACTA ACUST UNITED AC 2021; 75:325-333. [PMID: 34016548 DOI: 10.1016/j.rec.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 02/15/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Transcatheter aortic valve implant has become a widely accepted treatment for inoperable patients with aortic stenosis and patients at high surgical risk. Its indications have recently been expanded to include patients at intermediate and low surgical risk. Our aim was to evaluate the efficiency of SAPIEN 3 vs conservative medical treatment (CMT) or surgical aortic valve replacement (SAVR) in symptomatic inoperable patients at high or intermediate risk. METHODS We conducted a cost-effectiveness analysis of SAPIEN 3 vs SAVR/CMT, using a Markov model (monthly cycles) with 8 states defined by the New York Heart Association and a time horizon of 15 years, including major complications and management after hospital discharge, from the perspective of the National Health System. Effectiveness parameters were based on the PARTNER trials. Costs related to the procedure, hospitalization, complications, and follow-up were included (euros in 2019). An annual discount rate of 3% was applied to both costs and benefits. Deterministic and probabilistic sensitivity analyses (Monte Carlo) were performed. RESULTS Compared with SAVR (high and intermediate risk) and CMT (inoperable), SAPIEN 3 showed better clinical results in the 3 populations and lower hospital stay. Incremental cost-utility ratios (€/quality-adjusted life years gained) were 5471 (high risk), 8119 (intermediate risk) and 9948 (inoperable), respectively. In the probabilistic analysis, SAPIEN 3 was cost-effective in more than 75% of the simulations in the 3 profiles. CONCLUSIONS In our health system, SAPIEN 3 facilitates efficient management of severe aortic stenosis in inoperable and high- and intermediate-risk patients.
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Affiliation(s)
- Eduardo Pinar
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
| | - Juan García de Lara
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - José Hurtado
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Miguel Robles
- Servicio de Contabilidad de Ingresos y Gastos, Servicio Murciano de Salud, Murcia, Spain
| | - Gunnar Leithold
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Jesús Cuervo
- Axentiva Solutions, Santa Cruz de Tenerife, Spain
| | - Domingo A Pascual
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Carlos Crespo
- Axentiva Solutions, Santa Cruz de Tenerife, Spain; Departamento de Genética, Microbiología y Estadística, Universidad de Barcelona, Barcelona, Spain
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Rodríguez AA, Martínez Ó, Amayra I, López-Paz JF, Al-Rashaida M, Lázaro E, Caballero P, Pérez M, Berrocoso S, García M, Luna PM, Pérez-Núñez P, Passi N. Diseases Costs and Impact of the Caring Role on Informal Carers of Children with Neuromuscular Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2991. [PMID: 33803993 PMCID: PMC7999397 DOI: 10.3390/ijerph18062991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 01/06/2023]
Abstract
This study aims to evaluate the costs of informal care for children with neuromuscular disease and evaluate how physical and psychological health is associated with socio-demographic variables. A cross sectional design was used with a convenience sample of 110 carers that participated in this study. Participants were recruited from Spanish hospitals and rare diseases organizations. Economic costs and sociodemographic aspects were assessed using the economic costs questionnaire and the sociodemographic questionnaire. Physical and psychological health was evaluated using the CarerQol-7D, PHQ-15, Barthel Index, Zarit Overload Scale and Satisfaction with Life Scale. Carers of children with neuromuscular disease spent a large percentage of their annual income in physical therapy, psychological care and speech therapy. Informal costs differed according to the degree of dependency of the child. These were higher in those caregivers whose child under their care presented low functional independence. The loss of work productivity was related to marital status, use of professional services and the child's dependency. Finally, carers who were female, single or separated and without a job showed worse physical and psychological health. The results highlighted that carers have to face a number of high costs because of the non-existence of social protection and due to the child's diagnosis.
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Affiliation(s)
- Alicia Aurora Rodríguez
- Neuro-e-Motion Research Team, Faculty of Psychology and Education, University of Deusto, Av. Universidades, 24, 48007 Bilbao, Spain; (Ó.M.); (I.A.); (J.F.L.-P.); (M.A.-R.); (E.L.); (P.C.); (M.P.); (S.B.); (M.G.); (P.M.L.); (P.P.-N.); (N.P.)
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Gorostiza A, Arrospide A, Larrañaga I, Barandiarán A, Ruiz de Austri A, Ibarrondo O, Mar J. Dynamic evaluation of the comparative effectiveness of an integrated program for heart failure care. J Eval Clin Pract 2021; 27:134-142. [PMID: 32367623 DOI: 10.1111/jep.13402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES An integrated care program for heart failure (HF) was developed in the Basque Country in 2013. The objective of this research was to evaluate its effectiveness through the number of hospital admissions in three integrated healthcare organizations (IHOs), taking into account the longitudinal nature of the disease and the intensity of the implementation. METHODS A retrospective observational study was carried out, based on data entered in administrative and clinical databases between 2014 and 2018 for a total population of 230 000. In addition to conventional statistical analyses, Andersen-Gill models for recurrent events were used, incorporating dynamic variables that allowed assessment of the intervention's intensity before each hospitalization. RESULTS A total of 6768 patients were analysed. Age (hazard ratio [HR] = 1.016; 95% confidence interval [CI] 1.011-1.022), the Charlson index (HR = 1.067, 95% CI 1.047-1.087), and the number of previous hospitalizations (HR = 1.632, 95% CI 1.557-1.712) were risk factors for readmission. Differences between IHOs were also statistically significant. Greater intervention intensity was associated with a lower hospitalization rate (HR = 0.995, 95% CI 0.990-1.000). As indicated by the interaction between intervention intensity and IHO, differences between IHOs disappeared when intensity rose. No inequities in hospitalization were found as a function of deprivation index or sex. Nonetheless, inequity in the implementation of the program by sex was clear, women with HF receiving less intense intervention than men with the same level of comorbidity and age. CONCLUSIONS The extent of program implementation measured by intervention intensity is a main driver of the effectiveness of an educational and monitoring program for HF. The evaluation of HF program effectiveness on readmissions must take into account the entire natural history of the disease. Implementation intensity explains differences between IHOs.
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Affiliation(s)
- Ania Gorostiza
- Alto Deba Integrated Health Care Organization, AP-OSIs Gipuzkoa Research Unit, Arrasate-Mondragón, Spain.,Biodonostia Health Research Institute, Public Health Area, Donostia-SanSebastián, Spain
| | - Arantzazu Arrospide
- Alto Deba Integrated Health Care Organization, AP-OSIs Gipuzkoa Research Unit, Arrasate-Mondragón, Spain.,Biodonostia Health Research Institute, Public Health Area, Donostia-SanSebastián, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Public Health Area, Bilbao, Spain
| | - Igor Larrañaga
- Alto Deba Integrated Health Care Organization, AP-OSIs Gipuzkoa Research Unit, Arrasate-Mondragón, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Public Health Area, Bilbao, Spain
| | - Aitziber Barandiarán
- Goierri-Alto Urola Integrated Health Care Organization, Health Management Unit, Zumarraga, Gipuzkoa, Spain
| | - Adolfo Ruiz de Austri
- Alto Deba Integrated Health Care Organization, Arrasate-Mondragón Primary Care Unit, Arrasate-Mondragón, Gipuzkoa, Spain
| | - Oliver Ibarrondo
- Alto Deba Integrated Health Care Organization, AP-OSIs Gipuzkoa Research Unit, Arrasate-Mondragón, Spain.,Biodonostia Health Research Institute, Public Health Area, Donostia-SanSebastián, Spain
| | - Javier Mar
- Alto Deba Integrated Health Care Organization, AP-OSIs Gipuzkoa Research Unit, Arrasate-Mondragón, Spain.,Biodonostia Health Research Institute, Public Health Area, Donostia-SanSebastián, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Public Health Area, Bilbao, Spain
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Kanters TA, Brugts JJ, Manintveld OC, Versteegh MM. Burden of Providing Informal Care for Patients with Atrial Fibrillation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:236-243. [PMID: 33518030 DOI: 10.1016/j.jval.2020.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/07/2020] [Accepted: 09/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Patients with atrial fibrillation (AF) have rapid and irregular heart rates, increasing the risk of comorbidities and mortality. Next to formal medical care, many patients receive informal care from their social environment. The objective of this study was to examine the well-being and economic burden of providing informal care to patients with AF in the UK, Italy, and Germany. METHODS Caregivers of patients with AF completed an online survey based on the iMTA Valuation of Informal Care Questionnaire, with questions about their caregiving situation, perceived burden of caregiving, and absence from work due to health problems resulting from caregiving. Care-related quality-of-life utilities were calculated using the Care-related Quality of Life instrument and associated tariffs. Societal costs of caregiving were calculated based on the proxy good method. RESULTS A total of 585 caregivers participated in this study. On average, caregivers provided 33 hours of informal care per week to patients (SD 29 hours). On a scale from 0 to 10, their self-rated burden was 5.4. The average Care-related Quality of Life utility was 72. Caregivers primarily indicated problems with daily activities, mental health, and physical health. Still, the vast majority of caregivers (87%) derived fulfillment from providing care. Weekly societal costs of caregiving were on average €636. Comorbidities contributed substantially to the caregiver time and burden. CONCLUSIONS Caring for a patient with AF is associated with substantial objective and subjective burden, but also provides fulfillment from being able to care for a loved one.
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Affiliation(s)
- Tim A Kanters
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Matthijs M Versteegh
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Delgado JF, Oliva J, González-Franco Á, Cepeda JM, García-García JÁ, González-Domínguez A, Garcia-Casanovas A, Jiménez Merino S, Comín-Colet J. Budget impact of ferric carboxymaltose treatment in patients with chronic heart failure and iron deficiency in Spain. J Med Econ 2020; 23:1418-1424. [PMID: 33073660 DOI: 10.1080/13696998.2020.1838872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The treatment of iron deficiency (ID) with ferric carboxymaltose (FCM) improves the functional class and quality of life of chronic heart failure (CHF) patients with reduced left ventricular ejection fraction (LVEF), and reduces the rate of hospitalization due to worsening CHF. This study aims to evaluate the budget impact for the Spanish National Health System (SNHS) of treating ID in reduced LVEF CHF with FCM compared to non-iron treatment. METHODS We simulated a hypothetical cohort of 1000 CHF patients with ID and reduced LVEF based on the Spanish population characteristics. A decision-analytic model was also built using the data from the largest FCM clinical trial (CONFIRM-HF) that lasted for a year. We considered the use of healthcare resources from a national prospective study. A deterministic sensitivity analysis was carried out varying the corresponding baseline data by ±25%. RESULTS The cost of treating the simulated population with FCM was €2,570,914, while that of the non-iron treatment was €3,105,711, which corresponds to a cost saving of €534,797 per 1,000 patients in one year. Cost savings were mainly due to a decrease in the number of hospitalizations. All sensitivity analysis showed cost savings for the SNHS. CONCLUSIONS FCM results in an annual cost saving of €534.80 per patient, and would thus be expected to reduce the economic burden of CHF in Spain.
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Affiliation(s)
- Juan F Delgado
- Cardiology Service, Hospital Universitario 12 de Octubre, Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Faculty of Medicine, Complutense University, Madrid, Spain
| | - Juan Oliva
- Department of Economic Analysis, University of Castilla-La Mancha, Toledo, Spain
| | - Álvaro González-Franco
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Asturias, Spain
- Heart Failure and Atrial Fibrillation Group, Spanish Society of Internal Medicine (SEMI)
| | - Jose María Cepeda
- Department of Internal Medicine, Hospital Vega Baja de Orihuela, Alicante, Spain
| | | | | | | | | | - Josep Comín-Colet
- Community Heart Failure Program, Department of Cardiology, Hospital Universitario de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
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Escobar C, Varela L, Palacios B, Capel M, Sicras A, Sicras A, Hormigo A, Alcázar R, Manito N, Botana M. Costs and healthcare utilisation of patients with heart failure in Spain. BMC Health Serv Res 2020; 20:964. [PMID: 33081776 PMCID: PMC7576860 DOI: 10.1186/s12913-020-05828-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Increasing the knowledge about heart failure (HF) costs and their determinants is important to ascertain how HF management can be optimized, leading to a significant decrease of HF costs. This study evaluated the cumulative costs and healthcare utilisation in HF patients in Spain. METHODS Observational, retrospective, population-based study using BIG-PAC database, which included data from specialized and primary care of people ≥18 years, from seven autonomous communities in Spain, who received care for HF between 2015 and 2019. The healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019. RESULTS We identified 17,163 patients with HF (year 2015: mean age 77.3 ± 11.8 years, 53.5% men, 51.7% systolic HF, 43.6% on NYHA functional class II). During the 2015-2019 period, total HF associated costs reached 15,373 Euros per person, being cardiovascular disease hospitalizations the most important determinant (75.8%), particularly HF hospitalizations (51.0%). Total medication cost accounted for 7.0% of the total cost. During this period, there was a progressive decrease of cardiovascular disease hospital costs per year (from 2834 Euros in 2015 to 2146 Euros in 2019, P < 0.001), as well as cardiovascular and diabetic medication costs. CONCLUSIONS During the 2015-2019 period, costs of HF patients in Spain were substantial, being HF hospitalizations the most important determinant. Medication costs represented only a small proportion of total costs. Improving HF management, particularly through the use of drugs that reduce HF hospitalization may be helpful to reduce HF burden.
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Affiliation(s)
| | | | | | | | - Antoni Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | - Aram Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | | | | | - Nicolás Manito
- Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Camps-Vilaró A, Delgado-Jiménez JF, Farré N, Tizón-Marcos H, Álvarez-García J, Cinca J, Dégano IR, Marrugat J. Estimated Population Prevalence of Heart Failure with Reduced Ejection Fraction in Spain, According to DAPA-HF Study Criteria. J Clin Med 2020; 9:E2089. [PMID: 32635219 PMCID: PMC7408645 DOI: 10.3390/jcm9072089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/22/2022] Open
Abstract
Heart failure (HF) is one of the main causes of morbidity, mortality, and high healthcare costs. Dapagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, reduced cardiovascular mortality and hospitalization for HF compared to placebo in patients with chronic HF, and reduced ejection fraction (EF) in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) study. Our aim was to estimate the number of patients with DAPA-HF characteristics in Spain. Our literature review identified epidemiological studies whose objective was to quantify the prevalence of HF and its comorbidities in Spain. We estimated the prevalence of HF with reduced EF, of New York Heart Association (NYHA) functional class II-IV, and with a glomerular filtration rate (GFR) ≥ 30 mL/min/1.73 m². In this population, we analysed the prevalence of diabetes using data from the REDINSCOR (Spanish Network for Heart Failure) registry. Our estimations indicate there are 594,684 patients ≥45 years old with HF in Spain (2.6% of this population age group), of which 52.4%, 84.0%, and 93.9% have reduced EF, are NYHA II-IV, and have a GFR ≥ 30 mL/min/1.73 m², respectively. By our calculations, approximately 245,789 Spanish patients would meet the DAPA-HF patient profile, and therefore could benefit from the protective cardiovascular effects of dapagliflozin.
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Affiliation(s)
- Anna Camps-Vilaró
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (J.F.D.-J.); (J.Á.-G.); (J.C.)
| | - Juan F. Delgado-Jiménez
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (J.F.D.-J.); (J.Á.-G.); (J.C.)
- Department of Cardiology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid (UCM), 28040 Madrid, Spain
| | - Núria Farré
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (N.F.); (H.T.-M.)
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
- Faculty of Medicine, Universitat Autónoma de Barcelona (UAB), 08193 Barcelona, Spain
| | - Helena Tizón-Marcos
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (N.F.); (H.T.-M.)
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Jesús Álvarez-García
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (J.F.D.-J.); (J.Á.-G.); (J.C.)
- Faculty of Medicine, Universitat Autónoma de Barcelona (UAB), 08193 Barcelona, Spain
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Juan Cinca
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (J.F.D.-J.); (J.Á.-G.); (J.C.)
- Faculty of Medicine, Universitat Autónoma de Barcelona (UAB), 08193 Barcelona, Spain
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Irene R. Dégano
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (J.F.D.-J.); (J.Á.-G.); (J.C.)
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
| | - Jaume Marrugat
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (J.F.D.-J.); (J.Á.-G.); (J.C.)
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Oyanguren J, Garcia-Garrido L, Nebot-Margalef M, Latorre-García P, Torcal-Laguna J, Comín-Colet J, Roure J, González-Costello J, Manito N, García-Pinilla JM, Sánchez-Paule Y, Varela-Román A, Moure M, Segovia-Cubero J, Soria T, Arana-Arri E, Lekuona I. Noninferiority of heart failure nurse titration versus heart failure cardiologist titration. ETIFIC multicenter randomized trial. ACTA ACUST UNITED AC 2020; 74:533-543. [PMID: 32591295 DOI: 10.1016/j.rec.2020.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 04/16/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND OBJECTIVES Beta-blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin-II-receptor-blockers (ARB), and mineralocorticoid-receptor antagonists decrease mortality and heart failure (HF) hospitalizations in HF patients with reduced left ventricular ejection fraction. The effect is dose-dependent. Careful titration is recommended. However, suboptimal doses are common in clinical practice. This study aimed to compare the safety and efficacy of dose titration of the aforementioned drugs by HF nurses vs HF cardiologists. METHODS ETIFIC was a multicenter (n=20) noninferiority randomized controlled open label trial. A total of 320 hospitalized patients with new-onset HF, reduced ejection fraction and New York Heart Association II-III, without beta-blocker contraindications were randomized 1:1 in blocks of 4 patients each stratified by hospital: 164 to HF nurse titration vs 156 to HF cardiologist titration (144 vs 145 analyzed). The primary endpoint was the beta-blocker mean relative dose (% of target dose) achieved at 4 months. Secondary endpoints included ACE inhibitors, ARB, and mineralocorticoid-receptor antagonists mean relative doses, associated variables, adverse events, and clinical outcomes at 6 months. RESULTS The mean±standard deviation relative doses achieved by HF nurses vs HF cardiologists were as follows: beta-blockers 71.09%±31.49% vs 56.29%±31.32%, with a difference of 14.8% (95%CI, 7.5-22.1), P <.001; ACE inhibitors 72.61%±29.80% vs 56.13%±30.37%, P <.001; ARB 44.48%±33.47% vs 43.51%±33.69%, P=.93; and mineralocorticoid-receptor antagonists 71%±32.12% vs 70.47%±29.78%, P=.86; mean±standard deviation visits were 6.41±2.82 vs 2.81±1.58, P <.001, while the number (%) of adverse events were 34 (23.6) vs 30 (20.7), P=.55; and at 6 months HF hospitalizations were 1 (0.69) vs 9 (5.51), P=.01. CONCLUSIONS ETIFIC is the first multicenter randomized trial to demonstrate the noninferiority of HF specialist-nurse titration vs HF cardiologist titration. Moreover, HF nurses achieved higher beta-blocker/ACE inhibitors doses, with more outpatient visits and fewer HF hospitalizations. Trial registry number: NCT02546856.
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Affiliation(s)
- Juana Oyanguren
- Servicio de Cardiología, Hospital Universitario Galdakao-Usansolo, OSI Barrualde-Galdakao-Osakidetza, Servicio Vasco de Salud, Galdakao, Bizkaia, Spain; BIOCRUCES, Instituto de Investigación Sanitaria, Bizkaia, Spain.
| | - Lluisa Garcia-Garrido
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Dr. Josep Trueta, Girona, Spain; Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain
| | - Magdalena Nebot-Margalef
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | | | | | - Josep Comín-Colet
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Julia Roure
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Dr. Josep Trueta, Girona, Spain; Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain
| | - José González-Costello
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Nicolás Manito
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - José M García-Pinilla
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Virgen de la Victoria, Málaga, Spain; Instituto de Investigación Sanitaria (IDIMA), Málaga, Spain
| | - Yolanda Sánchez-Paule
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Virgen de la Victoria, Málaga, Spain; Instituto de Investigación Sanitaria (IDIMA), Málaga, Spain
| | - Alfonso Varela-Román
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario de Santiago, Santiago de Compostela, La Coruña, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), La Coruña, Spain
| | - María Moure
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario de Santiago, Santiago de Compostela, La Coruña, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), La Coruña, Spain
| | - Javier Segovia-Cubero
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Servicio de Cardiología, Hospital Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
| | - Teresa Soria
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Servicio de Cardiología, Hospital Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
| | | | - Iñaki Lekuona
- Servicio de Cardiología, Hospital Universitario Galdakao-Usansolo, OSI Barrualde-Galdakao-Osakidetza, Servicio Vasco de Salud, Galdakao, Bizkaia, Spain
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Análisis económico del tratamiento ambulatorio intermitente con levosimendán de la insuficiencia cardiaca avanzada en España. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Merino M, Jiménez M, Manito N, Casariego E, Ivanova Y, González‐Domínguez A, San Saturnino M, Hidalgo‐Vega Á, Blanch C. The social return on investment of a new approach to heart failure in the Spanish National Health System. ESC Heart Fail 2020; 7:130-137. [PMID: 31916416 PMCID: PMC7083495 DOI: 10.1002/ehf2.12535] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 09/12/2019] [Accepted: 09/17/2019] [Indexed: 11/11/2022] Open
Abstract
AIMS We aim to agree on a set of proposals to improve the current management of heart failure (HF) within the Spanish National Health System (SNHS) and apply the social return on investment (SROI) method to measure the social impact that these proposals would generate. METHODS AND RESULTS A multidisciplinary working team of 16 experts was set up, with representation from the main stakeholders regarding HF: medical specialists (cardiologists, internal medicine physicians, general practitioners, and geriatric physicians), nursing professionals, health management professionals, patients, and informal caregivers. This team established a set of proposals to improve the management of HF according to the main areas of HF care: emergency and hospitalization, primary care, cardiology, and internal medicine. A forecast-type SROI method, with a 1-year time frame, was applied to measure the social impact resulting from the implementation of these proposals. The required investment and social return were estimated and summarized into a ratio indicating how much social return could be generated for each euro invested. Intangible returns were included and quantified through financial proxies. The approach to improve the management of HF consisted of 28 proposals, including the implementation of a case management nurse network, standardization of operational protocols, psychological support, availability of echocardiography machines at emergency departments, stationary units and primary care, early specialist visits after hospital discharge, and cardiac rehabilitation units, among others. These proposals would benefit not only patients and their informal caregivers but also the SNHS. Regarding patients, proposals would increase their autonomy in everyday activities, decrease anxiety, increase psychological and physical well-being, improve pharmacological adherence and self-care, enhance understanding of the disease, delay disease progression, expedite medical assessment, and prevent the decrease in work productivity associated with HF management. Regarding informal caregivers, proposals would increase their quality of life; improve their social, economic, and emotional well-being; and reduce their care burden. The SNHS would benefit from shorter stays of HF patients at intensive care units and reduction of hospitalizations and admissions to emergency departments. The investment needed to implement these proposals would amount to €548m and yield a social return of €1932m, that is, €3.52 for each euro invested. CONCLUSIONS The current management of HF could be improved by a set of proposals that resulted in an overall positive social return, varying between areas of analysis. This may guide the allocation of healthcare resources and improve the quality of life of patients with HF.
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Affiliation(s)
- María Merino
- Department of Health Outcomes ResearchInstituto Max WeberMadridSpain
| | - Margarita Jiménez
- Department of Pharmacoeconomics and Market AccessInstituto Max WeberMadridSpain
| | - Nicolás Manito
- Department of Heart Failure and TransplantHospital Universitario de Bellvitge, Hospitalet de LlobregatBarcelonaSpain
| | - Emilio Casariego
- Department of Internal MedicineComplejo Hospitalario de LugoLugoSpain
| | - Yoana Ivanova
- Department of Pharmacoeconomics and Market AccessInstituto Max WeberMadridSpain
| | | | | | - Álvaro Hidalgo‐Vega
- Economy and Health Research SeminarUniversidad de Castilla‐La ManchaToledoSpain
| | - Carles Blanch
- Early Access & Health EconomicsNovartisBarcelonaSpain
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Gouveia MRDA, Ascenção RMSES, Fiorentino F, Costa JNMPGD, Broeiro-Gonçalves PM, Fonseca MCFGD, Borges MDFPF. Current costs of heart failure in Portugal and expected increases due to population aging. Rev Port Cardiol 2020; 39:3-11. [PMID: 31973946 DOI: 10.1016/j.repc.2019.09.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 04/24/2019] [Accepted: 09/16/2019] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is a growing public health problem. This study estimates the current and future costs of HF in mainland Portugal. METHODS Costs were estimated based on prevalence and from a societal perspective. The annual costs of HF included direct costs (resource consumption) and indirect costs (productivity losses). Estimates were mostly based on data from the Diagnosis-Related Groups database, real-world data from primary care, and the opinions of an expert panel. Costs were estimated for 2014 and, taking population aging into account, changes were forecast up to 2036. RESULTS Direct costs in 2014 were €299 million (39% for hospitalizations, 24% for medicines, 17% for exams and tests, 16% for consultations, and the rest for other needs, including emergencies and long-term care). Indirect costs were €106 million (16% for absenteeism and 84% for reduced employment). Between 2014 and 2036, due to demographic dynamics, total costs will increase from €405 to €503 million. Per capita costs are estimated to rise by 34%, which is higher than the increase in total costs (+24%), due to the expected reduction in the resident population. CONCLUSIONS HF currently has a significant economic impact, representing around 2.6% of total public health expenditure, and this is expected to increase in the future. This should be taken into account by health policy makers, alerting them to the need for resource management in order to mitigate the impact of this disease.
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Affiliation(s)
| | - Raquel Maria Sousa E Silva Ascenção
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Francesca Fiorentino
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | - João Nuno Marques Parracho Guerra da Costa
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Paula Maria Broeiro-Gonçalves
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Agrupamento de Centros de Saúde Lisboa Central, Unidade de Cuidados de Saúde Personalizados dos Olivais, Lisboa, Portugal
| | - Maria Cândida Faustino Gamito da Fonseca
- Clínica de Insuficiência Cardíaca, Serviço de Medicina III e Hospital de Dia Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Margarida de Fátima Palma Feria Borges
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Economic analysis of intermittent intravenous outpatient treatment with levosimendan in advanced heart failure in Spain. ACTA ACUST UNITED AC 2020; 73:361-367. [PMID: 31899185 DOI: 10.1016/j.rec.2019.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 06/26/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION AND OBJECTIVES Advanced heart failure (HF) leads to high hospitalization and mortality rates. The LION-HEART study was a randomized, placebo-controlled clinical trial that evaluated the safety and efficacy of intravenous administration of intermittent doses of levosimendan in outpatients with advanced HF. The aim of the present study was to perform a cost analysis to determine whether the lower rate of hospitalizations for HF, observed in patients treated with levosimendan in the LION-HEART study, can generate savings for the Spanish national health system compared with the option of not treating patients with advanced HF. METHODS An economic model was used that included IC hospitalization rates from the LION-HEART study, the costs of hospitalization due to HF and those of the acquisition and intravenous administration of levosimendan. The time horizon of the analysis was 12 months. Two analyses were carried out, one deterministic and the other probabilistic (second-order Monte Carlo simulation). RESULTS In the deterministic analysis, the total saving for each patient treated with levosimendan would amount to-€698.48. In the probabilistic analysis, the saving per patient treated with levosimendan would be-€849.94 (95%CI, €133.12 to-€2,255.31). The probability of savings with levosimendan compared with the no treatment option would be 94.8%. CONCLUSIONS Intermittent ambulatory treatment with levosimendan can generate savings for the Spanish national health system compared with the option of not treating patients with advanced HF.
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Gouveia MRDA, Ascenção RMSES, Fiorentino F, Costa JNMPGD, Broeiro-Gonçalves PM, Fonseca MCFGD, Borges MDFPF. Current costs of heart failure in Portugal and expected increases due to population aging. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2019.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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49
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Brito D. Heart failure: The value of evidence-supported decision-making. Rev Port Cardiol 2020; 39:13-16. [DOI: 10.1016/j.repc.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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50
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Heart failure: The value of evidence-supported decision-making. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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