1
|
Dewaswala N, Mishra V, Bhopalwala H, Minhas AK, Keshavamurthy S. Pathophysiology and Management of Heart Failure in the Elderly. Int J Angiol 2022; 31:251-259. [PMID: 36588873 PMCID: PMC9803556 DOI: 10.1055/s-0042-1758357] [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: 11/13/2022] Open
Abstract
The population of elderly adults is increasing globally. It has been projected that the population of adults aged 65 years will increase by approximately 80% by 2050 in the United States. Similarly, the elderly population is rising in other countries; a notable example being Japan where approximately 30% of the population are aged above 65 years. The pathophysiology and management of heart failure (HF) in this age group tend to have more intricacies than in younger age groups owing to the presence of multiple comorbidities. The normal aging biology includes progressive disruption at cellular and genetic levels and changes in molecular signaling and mechanical activities that contribute to myocardial abnormalities. Older adults with HF secondary to ischemic or valvular heart disease may benefit from surgical therapy, valve replacement or repair for valvular heart disease and coronary artery bypass grafting for coronary artery disease. While referring these patients for surgery, patient and family expectations and life expectations should be taken into account. In this review, we will cover the pathophysiology and the management of HF in the elderly, specifically discussing important geriatric domains such as frailty, cognitive impairment, delirium, polypharmacy, and multimorbidity.
Collapse
Affiliation(s)
- Nakeya Dewaswala
- Department of Cardiovascular Diseases, University of Kentucky, Lexington, Kentucky
| | - Vinayak Mishra
- Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Huzefa Bhopalwala
- Department of Internal Medicine, Appalachian Regional Healthcare, Whitesburg, Kentucky
| | - Abdul Khan Minhas
- Department of Internal Medicine, Forrest General Hospital, Hattiesburg, Mississippi
| | - Suresh Keshavamurthy
- Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| |
Collapse
|
2
|
Sousa RD, Gouveia M, Nunes da Silva C, Rodrigues AM, Cardoso G, Antunes AF, Canhao H, de Almeida JMC. Treatment-resistant depression and major depression with suicide risk-The cost of illness and burden of disease. Front Public Health 2022; 10:898491. [PMID: 36033799 PMCID: PMC9402971 DOI: 10.3389/fpubh.2022.898491] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/11/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Treatment-Resistant Depression (TRD) and Major Depression with Suicide Risk (MDSR) are types of depression with relevant effects on the health of the population and a potentially significant economic impact. This study estimates the burden of disease and the costs of illness attributed to Treatment-Resistant Depression and Major Depression with Suicide Risk in Portugal. Methods The disease burden for adults was quantified in 2017 using the Disability-Adjusted Life Years (DALYs) lost. Direct costs related to the health care system and indirect costs were estimated for 2017, with indirect costs resulting from the reduction in productivity. Estimates were based on multiple sources of information, including the National Epidemiological Study on Mental Health, the Hospital Morbidity Database, data from the Portuguese National Statistics Institute on population and causes of death, official data on wages, statistics on the pharmaceutical market, and qualified opinions of experts. Results The estimated prevalence of TRD, MDSR, and both types of depression combined was 79.4 thousand, 52.5 thousand, and 11.3 thousand patients, respectively. The disease burden (DALY) due to the disability generated by TRD alone, MDSR alone, and the joint prevalence was 25.2 thousand, 21 thousand, and 4.5 thousand, respectively, totaling 50.7 thousand DALYs. The disease burden due to premature death by suicide was 15.6 thousand DALYs. The estimated total disease burden was 66.3 thousand DALYs. In 2017, the annual direct costs with TRD and MDSR were estimated at € 30.8 million, with the most important components being medical appointments and medication. The estimated indirect costs were much higher than the direct costs. Adding work productivity losses due to reduced employment, absenteeism, presenteeism, and premature death, a total cost of € 1.1 billion was obtained. Conclusions Although TRD and MDSR represent relatively small direct costs for the health system, they have a relevant disease burden and extremely substantial productivity costs for the Portuguese economy and society, making TRD and MDSR priority areas for achieving health gains.
Collapse
Affiliation(s)
- Rute Dinis Sousa
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal,NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal,Episaúde – Associação Científica, Évora, Portugal,*Correspondence: Rute Dinis Sousa
| | - Miguel Gouveia
- Católica Lisbon School of Business and Economics, Universidade Católica Portuguesa, Lisboa, Portugal
| | - Catarina Nunes da Silva
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal,NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal,Episaúde – Associação Científica, Évora, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal,NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal,Episaúde – Associação Científica, Évora, Portugal
| | - Graça Cardoso
- Comprehensive Health Research Centre, Lisbon Institute of Global Mental Health, Lisbon, Portugal,Department of Mental Health, NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Ana Filipa Antunes
- Comprehensive Health Research Centre, Lisbon Institute of Global Mental Health, Lisbon, Portugal,Department of Mental Health, NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Helena Canhao
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal,NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal,Episaúde – Associação Científica, Évora, Portugal,National School of Public Health, UNL, Lisboa, Portugal
| | - José Miguel Caldas de Almeida
- Comprehensive Health Research Centre, Lisbon Institute of Global Mental Health, Lisbon, Portugal,Department of Mental Health, NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| |
Collapse
|
3
|
Ascenção R, Alarcão J, Araújo F, Costa J, Fiorentino F, Gil V, Gouveia M, Lourenço F, Mello e Silva A, Vaz Carneiro A, Borges M. Atherosclerosis in the primary health care setting: A real-word data study. Rev Port Cardiol 2022; 41:475-484. [DOI: 10.1016/j.repc.2021.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/22/2021] [Accepted: 03/10/2021] [Indexed: 11/26/2022] Open
|
4
|
de Carvalho Dutra A, Silva LL, Pedroso RB, Tchuisseu YP, da Silva MT, Bergamini M, Scheidt JFHC, Iora PH, do Lago Franco R, Staton CA, Vissoci JRN, Nihei OK, de Andrade L. The Impact of Socioeconomic Factors, Coverage and Access to Health on Heart Ischemic Disease Mortality in a Brazilian Southern State: A Geospatial Analysis. Glob Heart 2021; 16:5. [PMID: 33598385 PMCID: PMC7824986 DOI: 10.5334/gh.770] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 12/08/2020] [Indexed: 11/20/2022] Open
Abstract
Background No other disease has killed more than ischemic heart disease (IHD) for the past few years globally. Despite the advances in cardiology, the response time for starting treatment still leads patients to death because of the lack of healthcare coverage and access to referral centers. Objectives To analyze the spatial disparities related to IHD mortality in the Parana state, Brazil. Methods An ecological study using secondary data from Brazilian Health Informatics Department between 2013-2017 was performed to verify the IHD mortality. An spatial analysis was performed using the Global Moran and Local Indicators of Spatial Association (LISA) to verify the spatial dependency of IHD mortality. Lastly, multivariate spatial regression models were also developed using Ordinary Least Squares and Geographically Weighted Regression (GWR) to identify socioeconomic indicators (aging, income, and illiteracy rates), exam coverage (catheterization, angioplasty, and revascularization rates), and access to health (access index to cardiologists and chemical reperfusion centers) significantly correlated with IHD mortality. The chosen model was based on p < 0.05, highest adjusted R2 and lowest Akaike Information Criterion. Results A total of 22,920 individuals died from IHD between 2013-2017. The spatial analysis confirmed a positive spatial autocorrelation global between IDH mortality rates (Moran's I: 0.633, p < 0.01). The LISA analysis identified six high-high pattern clusters composed by 66 municipalities (16.5%). GWR presented the best model (Adjusted R2: 0.72) showing that accessibility to cardiologists and chemical reperfusion centers, and revascularization and angioplasty rates differentially affect the IHD mortality rates geographically. Aging and illiteracy rate presented positive correlation with IHD mortality rate, while income ratio presented negative correlation (p < 0.05). Conclusion Regions of vulnerability were unveiled by the spatial analysis where sociodemographic, exam coverage and accessibility to health variables impacted differently the IHD mortality rates in Paraná state, Brazil. Highlights The increase in ischemic heart disease mortality rates is related to geographical disparities.The IHD mortality is differentially associated to socioeconomic factors, exam coverage, and access to health.Higher accessibility to chemical reperfusion centers did not necessarily improve patient outcomes in some regions of the state.Clusters of high mortality rate are placed in regions with low amount of cardiologists, income and schooling.
Collapse
Affiliation(s)
- Amanda de Carvalho Dutra
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná, BR
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
| | - Lincoln Luís Silva
- Post-Graduation Program in Biosciences and Physiopathology, State University of Maringá, Maringá, Paraná, BR
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
| | - Raíssa Bocchi Pedroso
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná, BR
| | - Yolande Pokam Tchuisseu
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
- Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, US
| | - Mariana Teixeira da Silva
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná, BR
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
| | - Marcela Bergamini
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná, BR
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
| | - João Felipe Hermann Costa Scheidt
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
- Department of Medicine, State University of Maringá, Maringá, Paraná, BR
| | - Pedro Henrique Iora
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
- Department of Medicine, State University of Maringá, Maringá, Paraná, BR
| | - Rogério do Lago Franco
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná, BR
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
| | - Catherine Ann Staton
- Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, US
- Duke Global Health Institute, Duke University, Durham, North Carolina, US
| | - João Ricardo Nickenig Vissoci
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná, BR
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
- Duke Global Health Institute, Duke University, Durham, North Carolina, US
| | - Oscar Kenji Nihei
- Education, Letters and Health Center, State University of the West of Paraná, Foz do Iguaçu, Paraná, BR
| | - Luciano de Andrade
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná, BR
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR
- Department of Medicine, State University of Maringá, Maringá, Paraná, BR
| |
Collapse
|
5
|
Costa J, Alarcão J, Araujo F, Ascenção R, Caldeira D, Fiorentino F, Gil V, Gouveia M, Lourenço F, Mello E Silva A, Sampaio F, Vaz Carneiro A, Borges M. The burden of atherosclerosis in Portugal. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 7:154-162. [PMID: 32946553 PMCID: PMC7962771 DOI: 10.1093/ehjqcco/qcaa060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/17/2020] [Accepted: 08/04/2020] [Indexed: 12/30/2022]
Abstract
Aims This article sought to estimate the burden of disease attributable to atherosclerosis in mainland Portugal in 2016. Methods and results The burden of atherosclerosis was measured in disability-adjusted life years following the latest 2010 Global Burden of Disease (GBD) methodology. Disability-adjusted life years were estimated as the sum of years of life lost (YLL) with years lived with disability (YLD). The following clinical manifestations of atherosclerosis were included: ischaemic heart disease (IHD) (including acute myocardial infarction, stable angina, and ischaemic heart failure), ischaemic cerebrovascular disease (ICVD), and peripheral arterial disease (PAD). Years of life lost were estimated based on all-cause mortality data for the Portuguese population and mortality due to IHD, ICVD, and PAD for the year 2016 sourced from national statistics. Standard life expectancy was sourced from the GBD study. Years lived with disability corresponded to the product of the number of prevalent cases by an average disability weight for all possible combinations of disease. Prevalence data for the different clinical manifestations of atherosclerosis were sourced from epidemiological studies. Disability weights were sourced from the published literature. In 2016, 15 123 deaths were attributable to atherosclerosis, which corresponded to 14.3% of overall mortality in mainland Portugal. Disability-adjusted life years totalled 260 943, 75% due to premature death (196 438 YLL) and 25% due to disability (64 505 YLD). Conclusion Atherosclerosis entails a high disease burden to society. A large part of this burden would be avoidable if evidence-based effective and cost-effective interventions targeting known risk factors, from prevention to treatment, were implemented.
Collapse
Affiliation(s)
- João Costa
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Joana Alarcão
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Francisco Araujo
- Serviço de Medicina, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514 Loures, Portugal
| | - Raquel Ascenção
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Instituto de Medicina Preventiva, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Centro Cardiovascular da Universidade de Lisboa e Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Daniel Caldeira
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Centro Cardiovascular da Universidade de Lisboa e Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Francesca Fiorentino
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Victor Gil
- Unidade Cardiovascular, Hospital dos Lusíadas, R. Abílio Mendes 12, 1500-458 Lisboa, Portugal.,Departamento de Medicina, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Departamento de Medicina, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Miguel Gouveia
- Centro de Estudos Aplicados, Católica Lisbon School of Business and Economics, Universidade Católica Portuguesa, Palma de Cima, 1649-023 Lisboa, Portugal
| | - Francisco Lourenço
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Alberto Mello E Silva
- Sociedade Portuguesa de Aterosclerose, Av. José Malhoa, n.º 2, 1070-158 Lisboa, Portugal
| | - Filipa Sampaio
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Department of Public Health and Caring Sciences, Uppsala Biomedical Centre, Uppsala University, Husargatan 3, 751 22 Uppsala, Sweden
| | - António Vaz Carneiro
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Instituto de Saúde Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Margarida Borges
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Unidade de Farmacologia Clínica, Centro Hospitalar Lisboa Central EPE, Alameda Santo António dos Capuchos, 1169-050 Lisboa, Portugal
| |
Collapse
|
6
|
Rocha E. The global burden of disease: An information resource for policy-making and evaluation of health interventions. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.03.003] [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] Open
|
7
|
Rocha E. A carga global de doença: fonte de informação para a definição de políticas e avaliação de intervenções em saúde. Rev Port Cardiol 2017; 36:283-285. [DOI: 10.1016/j.repc.2017.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|