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Millard MJ, Ashburn NP, Snavely AC, Hashemian T, Supples M, Allen B, Christenson R, Madsen T, McCord J, Mumma B, Stopyra J, Wilkerson RG, Mahler SA. European Society of Cardiology 0/1-hour algorithm (high-sensitivity cardiac troponin T) performance across distinct age groups. Heart 2024; 110:838-845. [PMID: 38471727 DOI: 10.1136/heartjnl-2023-323621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/06/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND To determine if the European Society of Cardiology 0/1-hour (ESC 0/1-h) algorithm with high-sensitivity cardiac troponin T (hs-cTnT) meets the ≥99% negative predictive value (NPV) safety threshold for 30-day cardiac death or myocardial infarction (MI) in older, middle-aged and young subgroups. METHODS We conducted a subgroup analysis of adult emergency department patients with chest pain prospectively enrolled from eight US sites (January 2017 to September 2018). Patients were stratified into rule-out, observation and rule-in zones using the hs-cTnT ESC 0/1-h algorithm and classified as older (≥65 years), middle aged (46-64 years) or young (21-45 years). Patients had 0-hour and 1-hour hs-cTnT measures (Roche Diagnostics) and a History, ECG, Age, Risk factor and Troponin (HEART) score. Fisher's exact tests compared rule-out and 30-day cardiac death or MI rates between ages. NPVs with 95% CIs were calculated for the ESC 0/1-h algorithm with and without the HEART score. RESULTS Of 1430 participants, 26.9% (385/1430) were older, 57.4% (821/1430) middle aged and 15.7% (224/1430) young. Cardiac death or MI at 30 days occurred in 12.8% (183/1430). ESC 0/1-h algorithm ruled out 35.6% (137/385) of older, 62.1% (510/821) of middle-aged and 79.9% of (179/224) young patients (p<0.001). NPV for 30-day cardiac death or MI was 97.1% (95% CI 92.7% to 99.2%) among older patients, 98.4% (95% CI 96.9% to 99.3%) in middle-aged patients and 99.4% (95% CI 96.9% to 100%) among young patients. Adding a HEART score increased NPV to 100% (95% CI 87.7% to 100%) for older, 99.2% (95% CI 97.2% to 99.9%) for middle-aged and 99.4% (95% CI 96.6% to 100%) for young patients. CONCLUSIONS In older and middle-aged adults, the hs-cTnT ESC 0/1-h algorithm was unable to reach a 99% NPV for 30-day cardiac death or MI unless combined with a HEART score. TRIAL REGISTRATION NUMBER NCT02984436.
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Affiliation(s)
- Marissa J Millard
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Nicklaus P Ashburn
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Anna C Snavely
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Tara Hashemian
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael Supples
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Brandon Allen
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Robert Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Troy Madsen
- Department of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - James McCord
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Bryn Mumma
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Jason Stopyra
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Richard Gentry Wilkerson
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Simon A Mahler
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Garg M, Venugopalan V, Vouri SM, Diaby V, Iovine NM, Park H. Oral fluoroquinolones and risk of aortic aneurysm or dissection: A nationwide population-based propensity score-matched cohort study. Pharmacotherapy 2023; 43:883-893. [PMID: 37381584 DOI: 10.1002/phar.2841] [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: 01/10/2023] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 06/30/2023]
Abstract
STUDY OBJECTIVE To investigate risk of aortic aneurysm or dissection in patients using oral fluoroquinolones compared to those using macrolides in real-world clinical practice among a large US general population. DESIGN Retrospective cohort study design. DATA SOURCE MarketScan commercial and Medicare supplemental databases. PATIENTS Adults patients with at least one prescription fill for fluoroquinolone or macrolide antibiotics. INTERVENTION Fluoroquinolone or macrolide antibiotics. MEASUREMENTS AND MAIN RESULTS The primary outcome was estimated incidence of aortic aneurysm or dissection associated with the use of fluoroquinolones compared with macrolides during a 60-day follow-up period in a 1:1 propensity score-matched cohort. We identified 3,174,620 patients (1,587,310 in each group) after 1:1 propensity score matching. Crude incidence of aortic aneurysm or dissection was 1.9 cases per 1000 person-years among fluoroquinolone users and 1.2 cases per 1000 person-years among macrolide users. In multivariable Cox regression, compared with macrolides, the use of fluoroquinolones was associated with an increased risk of aortic aneurysm or dissection (aHR: 1.34; 95% CI: 1.17-1.54). The association was primarily driven by a high incidence of aortic aneurysm cases (95.8%). Results of sensitivity (e.g., fluoroquinolone exposure ranging from 7 to 14 days (aHR: 1.47; 95% CI: 1.26-1.71)) and subgroup analyses (e.g., ciprofloxacin (aHR: 1.26; 95% CI: 1.07-1.49) and levofloxacin (aHR: 1.44; 95% CI: 1.19-1.52)) remained consistent with main findings. CONCLUSIONS Fluoroquinolone use was associated with a 34% increased risk of aortic aneurysm or dissection compared with macrolide use among a general US population.
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Affiliation(s)
- Mahek Garg
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Veena Venugopalan
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Scott M Vouri
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Nicole M Iovine
- Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
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Welten SJGC, Remmelzwaal S, Blom MT, van der Heijden AA, Nijpels G, Tan HL, van Valkengoed I, Empana JP, Jouven X, Ågesen FN, Warming PE, Tfelt-Hansen J, Prescott E, Jabbari R, Elders PJM. Validation of the ARIC prediction model for sudden cardiac death in the European population: The ESCAPE-NET project: Predicting sudden cardiac death in European adults. Am Heart J 2023; 262:55-65. [PMID: 37084935 DOI: 10.1016/j.ahj.2023.03.018] [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: 11/01/2022] [Revised: 03/20/2023] [Accepted: 03/31/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Sudden cardiac death is responsible for 10-20% of all deaths in Europe. The current study investigates how well the risk of sudden cardiac death can be predicted. To this end, we validated a previously developed prediction model for sudden cardiac death from the Atherosclerosis Risk in Communities study (USA). METHODS Data from participants of the Copenhagen City Heart Study (CCHS) (n=9988) was used to externally validate the previously developed prediction model for sudden cardiac death. The model's performance was assessed through discrimination (C-statistic) and calibration by the Hosmer-Lemeshow goodness-of-fit (HL) statistics suited for censored data and visual inspection of calibration plots. Additional validation was performed using data from the Hoorn Study (N=2045), employing the same methods. RESULTS During ten years of follow-up of CCHS participants (mean age: 58.7 years, 56.2% women), 425 experienced SCD (4.2%). The prediction model showed good discrimination for sudden cardiac death risk (C-statistic: 0.81, 95% CI:0.79-0.83). Calibration was robust (HL statistic: p=0.8). Visual inspection of the calibration plot showed that the calibration could be improved. Sensitivity was 89.8%, and specificity was 60.6%. The positive and negative predictive values were 10.1% and 99.2%. Model performance was similar in the Hoorn Study (C-statistic: 0.81, 95% CI: 0.77-0.85 and the HL statistic: 1.00). CONCLUSION Our study showed that the previously developed prediction model in North American adults performs equally well in identifying those at risk for sudden cardiac death in a general North-West European population. However, the positive predictive value is low.
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Affiliation(s)
- Sabrina J G C Welten
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of General practice, de Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Health behaviors & chronic diseases, Amsterdam, The Netherlands.
| | - Sharon Remmelzwaal
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of General practice, de Boelelaan 1117, Amsterdam, Netherlands; Department of Epidemiology and Data Science, Amsterdam University Medical Center, location VU, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Marieke T Blom
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of General practice, de Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Health behaviors & chronic diseases, Amsterdam, The Netherlands
| | - Amber A van der Heijden
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of General practice, de Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Health behaviors & chronic diseases, Amsterdam, The Netherlands
| | - Giel Nijpels
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of General practice, de Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Health behaviors & chronic diseases, Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Netherlands Heart Institute, Utrecht, The Netherlands
| | - Irene van Valkengoed
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jean-Philippe Empana
- Université Paris Cité, INSERM, U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, France; Sudden Cardiac Expertise Centre, Paris, France
| | - Xavier Jouven
- Université Paris Cité, INSERM, U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, France; Sudden Cardiac Expertise Centre, Paris, France
| | - Frederik Nybye Ågesen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peder Emil Warming
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.; Section of Forensic Genetics, Department of Forensic Medicine, Copenhagen University, Denmark
| | - Eva Prescott
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Reza Jabbari
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Petra J M Elders
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of General practice, de Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Health behaviors & chronic diseases, Amsterdam, The Netherlands
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Bretthauer M, Løberg M, Kaminski MF. Colonoscopy Screening and Colorectal Cancer Incidence and Mortality. Reply. N Engl J Med 2023; 388:378-379. [PMID: 36720141 DOI: 10.1056/nejmc2215192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
| | | | - Michal F Kaminski
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
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Wan X, Lighthall NR, Paulson D. Subjective markers of successful aging and change in Internet use among older adults: The distinctive role of subjective health. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2021.107064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ermini Leaf D, Tysinger B, Goldman DP, Lakdawalla DN. Predicting quantity and quality of life with the Future Elderly Model. HEALTH ECONOMICS 2021; 30 Suppl 1:52-79. [PMID: 33026140 PMCID: PMC8075077 DOI: 10.1002/hec.4169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/02/2020] [Accepted: 09/12/2020] [Indexed: 06/11/2023]
Abstract
The Future Elderly Model (FEM) is a microsimulation model designed to forecast health status, longevity, and a variety of economic outcomes. Compared to traditional actuarial models, microsimulation models provide greater opportunities for policy forecasting and richer detail, but they typically build upon smaller samples of data that may mitigate forecasting accuracy. We perform validation analyses of the FEM's mortality and quality of life forecasts using a version of the FEM estimated exclusively on early waves of data from the Health and Retirement Study. First, we compare FEM mortality and longevity projections to the actual mortality and longevity experience observed over the same period of time. We also compare the FEM results to actuarial forecasts of mortality and longevity during the same time. We find that FEM projections are generally in line with observed mortality rates and closely match longevity. Then, we assess the FEM's performance at predicting quality of life and longitudinal outcomes, two features missing from traditional actuarial models. Our analysis suggests the FEM performs at least as well as actuarial forecasts of mortality, while providing policy simulation features that are not available in actuarial models.
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Affiliation(s)
- Duncan Ermini Leaf
- University of Southern California, Leonard D. Schaeffer Center for Health Policy and Economics, Los Angeles, California, USA
| | - Bryan Tysinger
- University of Southern California, Leonard D. Schaeffer Center for Health Policy and Economics, Los Angeles, California, USA
| | - Dana P Goldman
- University of Southern California, Leonard D. Schaeffer Center for Health Policy and Economics, Los Angeles, California, USA
| | - Darius N Lakdawalla
- University of Southern California, Leonard D. Schaeffer Center for Health Policy and Economics, Los Angeles, California, USA
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Atella V, Belotti F, Kim D, Goldman D, Gracner T, Piano Mortari A, Tysinger B. The future of the elderly population health status: Filling a knowledge gap. HEALTH ECONOMICS 2021; 30 Suppl 1:11-29. [PMID: 33772966 DOI: 10.1002/hec.4258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 02/05/2021] [Accepted: 02/21/2021] [Indexed: 06/12/2023]
Abstract
The aging process in OECD countries calls for a better understanding of the future disease prevalence, life expectancy (LE) and patterns of inequalities in health outcomes. In this paper we present the results obtained from several dynamic microsimulation models of the Future Elderly Model family for 12 OECD countries, with the aim of reproducing for the first time comparable long-term projections in individual health status across OECD countries. We provide projections of LE and prevalence of major chronic conditions and disabilities, overall, by gender and by education. We find that the prevalence of main chronic conditions in Europe is catching-up with the United States and significant heterogeneity in the evolution of gender and educational gradients. Our findings represent a contribution to support policymakers in designing and implementing effective interventions in the healthcare sector.
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Affiliation(s)
- Vincenzo Atella
- Department of Economics and Finance, University of Rome "Tor Vergata", Rome, Italy
| | - Federico Belotti
- Department of Economics and Finance, University of Rome "Tor Vergata", Rome, Italy
| | - Daejung Kim
- Korea Institute for Health and Social Affairs (KIHASA), Sejong City, South Korea
| | - Dana Goldman
- University of Southern California, Los Angeles, California, USA
| | | | - Andrea Piano Mortari
- Centre for Economic and International Studies. University of Rome "Tor Vergata", Rome, Italy
| | - Bryan Tysinger
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
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Jelani QUA, Smolderen KG, Halpin D, Gosch K, Spertus JA, Iyad Ochoa Chaar C, Tutein Nolthenius RP, Heyligers J, De Vries JP, Mena-Hurtado C. Patient profiles and health status outcomes for peripheral artery disease in high-income countries: a comparison between the USA and The Netherlands. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:505-512. [PMID: 32539108 DOI: 10.1093/ehjqcco/qcaa052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/29/2020] [Accepted: 06/08/2020] [Indexed: 12/24/2022]
Abstract
AIMS Peripheral artery disease (PAD) is a global disease. Understanding variability in patient profiles and PAD-specific health status outcomes across health system countries can provide insights into improving PAD care. We compared these features between two high-income countries, the USA and The Netherlands. METHODS AND RESULTS Patients were identified from the patient-centred outcomes related to treatment practices in peripheral arterial disease: investigating trajectories study-a prospective, international registry of patients presenting to vascular specialty clinics for new onset, or exacerbation of PAD symptoms. PAD-specific health status was measured with the peripheral artery questionnaire. General linear mixed models for repeated measures were used to study baseline, 3, 6, and 12-month PAD-specific health status outcomes (peripheral artery questionnaire summary score) between the USA and The Netherlands. Out of a total of 1114 patients, 748 patients (67.1%) were from the USA and 366 (32.9%) from The Netherlands. US patients with PAD were older, with more financial barriers, higher cardiovascular risk factor burden, and lower referral rates for exercise treatment (P < 0.001). They had significantly worse PAD-specific adjusted health status scores at presentation, 3, 6, and 12 months of follow-up (all P < 0.0001). Magnitude of change in 1-year health status scores was smaller in the US cohort when compared with The Netherlands. CONCLUSION Compared with the Dutch cohort, US patients had worse adjusted PAD-specific health status scores at all time point, improving less over time, despite treatment. Leveraging inter-country differences in care and outcomes could provide important insights into optimizing PAD outcomes. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT01419080? term=portrait&rank=1 NCT01419080.
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Affiliation(s)
- Qurat-Ul-Ain Jelani
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, 20 York St, New Haven 06520, CT, USA
| | - Kim G Smolderen
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, 20 York St, New Haven 06520, CT, USA
| | - David Halpin
- David Halpin: Colorado Heart and Vascular Institute, 030 Mountain View Ave, Ste 300. Longmont, Colorado 80501, USA
| | - Kensey Gosch
- Saint Luke's Mid America Heart Institute/UMKC, 4401 Wornall Rd, Kansas Kansas City, MO 64111, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute/UMKC, 4401 Wornall Rd, Kansas Kansas City, MO 64111, USA.,University of Missouri-Kansas City, 5000 Holmes St., Kansas City, MO 64110, USA
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, 20 YorK Street, New Haven, CT 06520, USA
| | - Rudolf P Tutein Nolthenius
- Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands
| | - Jan Heyligers
- Department of Vascular Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.,Department of Surgery, St Elisabeth Hospital, Hilvarenbeekse Weg 60, 5022 GC Tilburg, The Netherlands
| | - Jean-Paul De Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Carlos Mena-Hurtado
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, 20 York St, New Haven 06520, CT, USA
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Somani S, Yoffie S, Teng S, Havaldar S, Nadkarni GN, Zhao S, Glicksberg BS. Development and validation of techniques for phenotyping ST-elevation myocardial infarction encounters from electronic health records. JAMIA Open 2021; 4:ooab068. [PMID: 34423260 PMCID: PMC8374370 DOI: 10.1093/jamiaopen/ooab068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/07/2021] [Accepted: 07/29/2021] [Indexed: 11/12/2022] Open
Abstract
Objectives Classifying hospital admissions into various acute myocardial infarction phenotypes in electronic health records (EHRs) is a challenging task with strong research implications that remains unsolved. To our knowledge, this study is the first study to design and validate phenotyping algorithms using cardiac catheterizations to identify not only patients with a ST-elevation myocardial infarction (STEMI), but the specific encounter when it occurred. Materials and Methods We design and validate multi-modal algorithms to phenotype STEMI on a multicenter EHR containing 5.1 million patients and 115 million patient encounters by using discharge summaries, diagnosis codes, electrocardiography readings, and the presence of cardiac catheterizations on the encounter. Results We demonstrate that robustly phenotyping STEMIs by selecting discharge summaries containing “STEM” has the potential to capture the most number of STEMIs (positive predictive value [PPV] = 0.36, N = 2110), but that addition of a STEMI-related International Classification of Disease (ICD) code and cardiac catheterizations to these summaries yields the highest precision (PPV = 0.94, N = 952). Discussion and Conclusion In this study, we demonstrate that the incorporation of percutaneous coronary intervention increases the PPV for detecting STEMI-related patient encounters from the EHR.
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Affiliation(s)
- Sulaiman Somani
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stephen Yoffie
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shelly Teng
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shreyas Havaldar
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Girish N Nadkarni
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shan Zhao
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin S Glicksberg
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Abstract
OBJECTIVE This analysis aimed to compare failure to rescue (FTR) after pancreatoduodenectomy across the Atlantic. SUMMARY BACKGROUND DATA FTR, or mortality after development of a major complication, is a quality metric originally created to compare hospital results. FTR has been studied in North American and Northern European patients undergoing pancreatoduodenectomy (PD). However, a direct comparison of FTR after PD between North America and Northern Europe has not been performed. METHODS Patients who underwent PD in North America, the Netherlands, Sweden and Germany (GAPASURG dataset) were identified from their respective registries (2014-17). Patients who developed a major complication defined as Clavien-Dindo ≥3 or developed a grade B/C postoperative pancreatic fistula (POPF) were included. Preoperative, intraoperative, and postoperative variables were compared between patients with and without FTR. Variables significant on univariable analysis were entered into a logistic regression for FTR. RESULTS Major complications occurred in 6188 of 22,983 patients (26.9%) after PD, and 504 (8.1%) patients had FTR. North American and Northern European patients with complications differed, and rates of FTR were lower in North America (5.4% vs 12%, P < 0.001). Fourteen factors from univariable analysis contributing to differences in patients who developed FTR were included in a logistic regression. On multivariable analysis, factors independently associated with FTR were age, American Society of Anesthesiology ≥3, Northern Europe, POPF, organ failure, life-threatening complication, nonradiologic intervention, and reoperation. CONCLUSIONS Older patients with severe systemic diseases are more difficult to rescue. Failure to rescue is more common in Northern Europe than North America. In stable patients, management of complications by interventional radiology is preferred over reoperation.
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Ammirati E, Brambatti M, Braun OÖ, Shah P, Cipriani M, Bui QM, Veenis J, Lee E, Xu R, Hong KN, Van de Heyning CM, Perna E, Timmermans P, Cikes M, Brugts JJ, Veronese G, Minto J, Smith S, Gjesdal G, Gernhofer YK, Partida C, Potena L, Masetti M, Boschi S, Loforte A, Jakus N, Milicic D, Nilsson J, De Bock D, Sterken C, Van den Bossche K, Rega F, Tran H, Singh R, Montomoli J, Mondino M, Greenberg B, Russo CF, Pretorius V, Liviu K, Frigerio M, Adler ED. Outcome of patients on heart transplant list treated with a continuous-flow left ventricular assist device: Insights from the TRans-Atlantic registry on VAd and TrAnsplant (TRAViATA). Int J Cardiol 2020; 324:122-130. [PMID: 32950592 DOI: 10.1016/j.ijcard.2020.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/28/2020] [Accepted: 09/08/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Geographic variations in management and outcomes of individuals supported by continuous-flow left ventricular assist devices (CF-LVAD) between the United States (US) and Europe (EU) is largely unknown. METHODS We created a retrospective, multinational registry of 524 patients who received a CF-LVAD (either HVAD or Heartmate II) between January 2008 and April 2017. Follow up spanned from date of CF-LVAD implant to post-HTx period with a median follow up of 44.8 months. RESULTS The cohort included 299 (57.1%) EU and 225 (42.9%) US patients. Although the US cohort was significantly older with a higher prevalence of comorbidities, survival was similar between the cohorts (US 63.1%, EU 68.4% at 5 years, unadjusted log-rank test p = 0.43).Multivariate analyses suggested that older age, higher body mass index, elevated creatinine, use of temporary mechanical circulatory support prior CF-LVAD, and implantation of HVAD were associated with increased mortality. Among CF-LVAD patients undergoing HTx, the median time on CF-LVAD support was shorter in the US, meanwhile US donors were younger. Finally, the pattern of adverse events (stroke, gastrointestinal bleedings, late right ventricular failure, and driveline infection) during support differed significantly between US and EU. CONCLUSIONS Although waitlisted patients in the US on CF-LVAD have higher risk comorbid conditions, the overall outcome is similar in US and EU. Geographic variations with regards to donor characteristics, duration of CF-LVAD support prior to transplant, and adverse events on support can explain the disparity in the utilization of mechanical bridge to transplant strategy between US and EU.
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Affiliation(s)
| | - Michela Brambatti
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Oscar Ö Braun
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Palak Shah
- Heart Failure and Transplantation, Inova Heart and Vascular Institute, Falls Church Virginia, USA
| | | | - Quan M Bui
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Jesse Veenis
- Erasmus MC Thoraxcenter, Rotterdam, the Netherlands
| | - Euyhyun Lee
- Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla, CA, USA
| | - Ronghui Xu
- Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla, CA, USA; Department of Mathematics and Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Kimberly N Hong
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | - Enrico Perna
- De Gasperis CardioCenter, Niguarda Hospital, Milano, Italy
| | | | - Maja Cikes
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Center Zagreb, Zagreb, Croatia
| | | | - Giacomo Veronese
- De Gasperis CardioCenter, Niguarda Hospital, Milano, Italy; Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Jonathan Minto
- Heart Failure and Transplantation, Inova Heart and Vascular Institute, Falls Church Virginia, USA
| | - Saige Smith
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Grunde Gjesdal
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Yan K Gernhofer
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | | | - Marco Masetti
- Academic Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Silvia Boschi
- Academic Hospital S. Orsola-Malpighi, Bologna, Italy
| | | | - Nina Jakus
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Center Zagreb, Zagreb, Croatia
| | - Davor Milicic
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Center Zagreb, Zagreb, Croatia
| | - Johan Nilsson
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Dina De Bock
- Department of Cardiology and Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium
| | | | | | | | - Hao Tran
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Ramesh Singh
- Heart Failure and Transplantation, Inova Heart and Vascular Institute, Falls Church Virginia, USA
| | - Jonathan Montomoli
- Anesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | | | - Barry Greenberg
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | - Victor Pretorius
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Klein Liviu
- University of California San Francisco, CA, USA
| | - Maria Frigerio
- De Gasperis CardioCenter, Niguarda Hospital, Milano, Italy
| | - Eric D Adler
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
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Côté-Sergent A, Fonseca R, Strumpf E. Comparing the education gradient in health deterioration among the elderly in six OECD countries. Health Policy 2020; 124:326-335. [PMID: 31982151 DOI: 10.1016/j.healthpol.2019.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/30/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
Inequalities in health by educational attainment are persistent both over time and across countries. However, their magnitudes, evolution, and main drivers are not necessarily consistent across jurisdictions. We examine the health deterioration-education gradient among older adults in the United States, Canada, France, the Netherlands, Spain and Italy, including how it changes over time between 2004 and 2010. Using longitudinal survey data, we first assess how rates of health deterioration in terms of poor health, difficulties with activities of daily living, and chronic conditions vary by educational attainment. We find systematic differences in rates of health deterioration, as well as in the health deterioration-education gradients, across countries. We then examine how potential confounders, including demographic characteristics, income, health care utilisation and health behaviours, affect the health deterioration-education gradient within countries over time. We demonstrate that while adjusting for confounders generally diminishes the health deterioration-education gradient, the impacts of these variables vary somewhat across countries. Our findings suggest that determinants of, and policy levers to affect, the health deterioration-education gradient likely vary across countries and health systems.
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Affiliation(s)
- Aurelie Côté-Sergent
- HEC Montréal, 3000 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 2A7, Canada.
| | - Raquel Fonseca
- ESG-UQAM, 315, Sainte-Catherine Street East, Montreal, QC, H2X 3X2, Canada; CIRANO, 130 Sherbrooke Street West #1400, Montreal, QC, H3A 2M8, Canada.
| | - Erin Strumpf
- CIRANO, 130 Sherbrooke Street West #1400, Montreal, QC, H3A 2M8, Canada; McGill University, 855 Sherbrooke Street West, Montreal, QC, H3A 2T7, Canada; CIREQ, 3150, Jean-Brillant Street, Montreal, QC, H3T 1N8, Canada.
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13
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Connolly MP, Panda S, Patris J, Hazenberg BPC. Estimating the fiscal impact of rare diseases using a public economic framework: a case study applied to hereditary transthyretin-mediated (hATTR) amyloidosis. Orphanet J Rare Dis 2019; 14:220. [PMID: 31533773 PMCID: PMC6751602 DOI: 10.1186/s13023-019-1199-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/05/2019] [Indexed: 12/27/2022] Open
Abstract
Background A wide range of rare diseases can have fiscal impacts on government finances that extend beyond expected healthcare costs. Conditions preventing people from achieving national lifetime work averages will influence lifetime taxes paid and increase the likelihood of dependence on public income support. Consequently, interventions that influence projected lifetime work activity, morbidity and mortality can have positive and negative fiscal consequences for government. The aim of this study was to apply a public economic framework to a rare disease that takes into consideration a broad range of costs that are relevant to government in relation to transfers received and taxes paid. As a case study we constructed a simulation model to calculate the fiscal life course of an individual with hereditary transthyretin-mediated (hATTR) amyloidosis in The Netherlands. In this lethal disease different progressive disease scenarios occur, including polyneuropathy and/or cardiomyopathy. Results Due to progressive disability, health care resource use, and early death, hATTR amyloidosis with polyneuropathy receives more transfers from government compared to the general population. In a scenario where a patient is diagnoses with hATTR at age 45, an individual pays €180,812 less in lifetime taxes and receives incrementally €111,695 in transfers from the government, compared to a person without hATTR. Patients suffering from cardiomyopathy die after median 4 years. The health costs of this scenario are therefore lower than that of the other polyneuropathy-based scenarios. Conclusions The fiscal analysis illustrates how health conditions influence not only health costs, but also the cross-sectorial public economic burden attributed to lost tax revenues and public disability allowances. Due to the progressive nature of hATTR amyloidosis used in this study, public costs including disability increase as the disease progresses with reduced lifetime taxes paid. The results indicate that halting disease progression early in the disease course would generate fiscal benefits beyond health benefits for patients. This analysis highlights the fiscal consequences of diseases and the need for broader perspectives applied to evaluate health conditions. Conventional cost-effectiveness framework used by many health technology assessment agencies have well-documented limitations in the field of rare diseases and fiscal modeling should be a complementary approach to consider.
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Affiliation(s)
- Mark P Connolly
- Global Market Access Solutions Sarl, St-Prex, Switzerland. .,Unit of Pharmacoepidemiology & Pharmacoeconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
| | - Saswat Panda
- Global Market Access Solutions Sarl, St-Prex, Switzerland
| | - Julien Patris
- Alnylam Pharmaceuticals, Strawinskylaan 3051, 1077 ZX, Amsterdam, The Netherlands
| | - Bouke P C Hazenberg
- Department of Rheumatology & Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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14
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Dashputre AA, Nemecek BD, Kamal KM, Covvey JR. The relationship between a cirrhosis-specific comorbidity scoring system and healthcare utilization patterns. J Gastroenterol Hepatol 2019; 34:1222-1230. [PMID: 30394572 DOI: 10.1111/jgh.14531] [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: 01/02/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Patients with liver cirrhosis are impacted by comorbidities that affect healthcare utilization and survival. The study objective was to assess the relationship between a cirrhosis-specific comorbidity scoring system (CirCom) and healthcare utilization among patients with cirrhosis. METHODS A retrospective cohort analysis was conducted using electronic medical records from a large academic-based healthcare network. Patients aged 18-90 years with at least one International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for cirrhosis (571.2/571.5) between 2009 and 2014, and at least 180 pre-index and 365 days of post-index electronic medical record data were included. Patients were assigned CirCom scores based on comorbidities observed at/before index cirrhosis diagnosis. All-cause/cirrhosis-specific outpatient/hospital utilization was assessed post-index diagnosis across 1 year. Predictors of utilization (age, sex, race, body mass index, etiology, Model for End-stage Liver Disease, and CirCom) were assessed using negative binomial and Poisson regression with robust standard errors. RESULTS A total of 957 patients were included. Healthcare utilization according to CirCom demonstrated a positive linear relationship for both all-cause outpatient/hospital utilization, but no relationship was evident for cirrhosis-specific utilization. Increased CirCom was associated with an increased risk of all-cause utilization for both outpatient (relative risk [RR]: 1.75; 95% confidence interval [CI]: 1.47-2.07) and hospital (RR: 1.71; 95% CI: 1.38-2.12) utilization. However, CirCom showed a statistically non-significant association for cirrhosis-specific outpatient (RR: 1.08; 95% CI: 0.91-1.29) and cirrhosis-specific hospital (RR: 0.87, 95% CI: 0.67-1.13) utilization. CONCLUSIONS CirCom failed to predict cirrhosis-specific healthcare utilization but did positively predict all-cause utilization for both outpatient and hospital services and therefore may be useful in risk assessment and management of cirrhosis.
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Affiliation(s)
- Ankur A Dashputre
- Institute for Health Outcomes and Policy, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Branden D Nemecek
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA.,University of Pittsburgh Medical Center - Mercy Hospital, Pittsburgh, Pennsylvania, USA
| | - Khalid M Kamal
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Jordan R Covvey
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
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15
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Chen C, Lim JT, Chia NC, Wang L, Tysinger B, Zissimopolous J, Chong MZ, Wang Z, Koh GC, Yuan JM, Tan KB, Chia KS, Cook AR, Malhotra R, Chan A, Ma S, Ng TP, Koh WP, Goldman DP, Yoong J. The Long-Term Impact of Functional Disability on Hospitalization Spending in Singapore. JOURNAL OF THE ECONOMICS OF AGEING 2019; 14:100193. [PMID: 31857943 PMCID: PMC6922027 DOI: 10.1016/j.jeoa.2019.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Singapore is one of the fastest-aging populations due to increased life expectancy and lowered fertility. Lifestyle changes increase the burden of chronic diseases and disability. These have important implications for social protection systems. The goal of this paper is to model future functional disability and healthcare expenditures based on current trends. To project the health, disability and hospitalization spending of future elders, we adapted the Future Elderly Model (FEM) to Singapore. The FEM is a dynamic Markov microsimulation model developed in the US. Our main source of population data was the Singapore Chinese Health Study (SCHS) consisting of 63,000 respondents followed up over three waves from 1993 to 2010. The FEM model enables us to investigate the effects of disability compounded over the lifecycle and hospitalization spending, while adjusting for competing risk of multi-comorbidities. Results indicate that by 2050, 1 in 6 elders in Singapore will have at least one ADL disability and 1 in 3 elders will have at least one IADL disability, an increase from 1 in 12 elders and 1 in 5 elders respectively in 2014. The highest prevalence of functional disability will be in those aged 85 years and above. Lifetime hospitalization spending of elders aged 55 and above is US$24,400 (30.2%) higher among people with functional disability compared to those without disability. Policies that successfully tackle diabetes and promote healthy living may reduce or delay the onset of disability, leading to potential saving. In addition, further technological improvements may reduce the financial burden of disability.
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Affiliation(s)
- C Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Schaeffer Center for Health Policy and Economics, University of Southern California, USA
| | - JT Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - NC Chia
- Department of Economics, National University of Singapore, Singapore
| | - L Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - B Tysinger
- Schaeffer Center for Health Policy and Economics, University of Southern California, USA
| | - J Zissimopolous
- Schaeffer Center for Health Policy and Economics, University of Southern California, USA
| | - MZ Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Z Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - GC Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - JM Yuan
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - KB Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Policy Research and Economics Office, Ministry of Health, Singapore
| | - KS Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - AR Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - R Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - A Chan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - S Ma
- Epidemiology & Disease Control Division, Ministry of Health, Singapore
| | - TP Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - WP Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - DP Goldman
- Schaeffer Center for Health Policy and Economics, University of Southern California, USA
| | - J Yoong
- Center for Economic and Social Research, University of Southern California, USA
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16
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Kabiri M, Brauer M, Shafrin J, Sullivan J, Gill TM, Goldman DP. Long-Term Health and Economic Value of Improved Mobility among Older Adults in the United States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:792-798. [PMID: 30005751 PMCID: PMC6078098 DOI: 10.1016/j.jval.2017.12.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Mobility impairments have substantial physical and mental health consequences, resulting in diminished quality of life. Most studies on the health economic consequences of mobility limitations focus on short-term implications. OBJECTIVES To examine the long-term value of improving mobility in older adults. METHODS Our six-step approach used clinical trial data to calibrate mobility improvements and estimate health economic outcomes using a microsimulation model. First, we measured improvement in steps per day calibrated with clinical trial data examining hylan G-F 20 viscosupplementation treatment. Second, we created a cohort of patients 51 years and older with osteoarthritis. In the third step, we estimated their baseline quality of life. Fourth, we translated steps-per-day improvements to changes in quality of life using estimates from the literature. Fifth, we calibrated quality of life in this cohort to match those in the trial. Last, we incorporated these data and parameters into The Health Economic Medical Innovation Simulation model to estimate how mobility improvements affect functional status limitations, medical expenditures, nursing home utilization, employment, and earnings between 2012 and 2030. RESULTS In our sample of 12.6 million patients, 66.7% were female and 70% had a body mass index of more than 25 kg/m2. Our model predicted that a 554-step-per-day increase in mobility would reduce functional status limitations by 5.9%, total medical expenditures by 0.9%, and nursing home utilization by 2.8%, and increase employment by 2.9%, earnings by 10.3%, and monetized quality of life by 3.2% over this 18-year period. CONCLUSIONS Interventions that improve mobility are likely to reduce long-run medical expenditures and nursing home utilization and increase employment.
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Affiliation(s)
- Mina Kabiri
- Precision Health Economics, 9433 Bee Cave Rd. Suite 252, Austin, TX 78733, 310-984-7375,
| | - Michelle Brauer
- Precision Health Economics, 11100 Santa Monica Blvd. Suite 500, Los Angeles, CA 90025, 310-984-7376,
| | - Jason Shafrin
- Precision Health Economics, 11100 Santa Monica Blvd. Suite 500, Los Angeles, CA 90025, 310-984-7705,
| | - Jeff Sullivan
- Precision Health Economics, 11100 Santa Monica Blvd. Suite 500, Los Angeles, CA 90025, 310-984-7730,
| | - Thomas M. Gill
- Yale School of Medicine, 20 York Street, New Haven, CT 06510,
| | - Dana P. Goldman
- University of Southern California, Schaeffer Center for Health Policy and Economics, 635 Downey Way, Los Angeles, CA 90089-3331, 213-821-7948,
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18
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Dijkink S, van der Wilden GM, Krijnen P, Dol L, Rhemrev S, King DR, DeMoya MA, Velmahos GC, Schipper IB. Polytrauma patients in the Netherlands and the USA: A bi-institutional comparison of processes and outcomes of care. Injury 2018; 49:104-109. [PMID: 29033079 DOI: 10.1016/j.injury.2017.10.021] [Citation(s) in RCA: 8] [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] [Received: 08/03/2017] [Revised: 09/29/2017] [Accepted: 10/09/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Modern trauma systems differ worldwide, possibly leading to disparities in outcomes. We aim to compare characteristics and outcomes of blunt polytrauma patients admitted to two Level 1 Trauma Centers in the US (USTC) and the Netherlands (NTC). METHODS For this retrospective study the records of 1367 adult blunt trauma patients with an Injury Severity Score (ISS) ≥ 16 admitted between July 1, 2011 and December 31, 2013 (640 from NTC, 727 from USTC) were analysed. RESULTS The USTC group had a higher Charlson Comorbidity Index (mean [standard deviation] 1.15 [2.2] vs. 1.73 [2.8], p<0.0001) and Injury Severity Score (median [interquartile range, IQR] 25 [17-29] vs. 21 [17-26], p<0.0001). The in-hospital mortality was similar in both centers (11% in USTC vs. 10% NTC), also after correction for baseline differences in patient population in a multivariable analysis (adjusted odds ratio 0.95, 95% confidence interval 0.61-1.48, p=0.83). USTC patients had a longer Intensive Care Unit stay (median [IQR] 4 [2-11] vs. 2 [2-7] days, p=0.006) but had a shorter hospital stay (median [IQR] 6 [3-13] vs. 8 [4-16] days, p<0.0001). USTC patients were discharged more often to a rehabilitation center (47% vs 10%) and less often to home (46% vs. 66%, p<0.0001), and had a higher readmission rate (8% vs. 4%, p=0.01). CONCLUSION Although several outcome parameters differ in two urban area trauma centers in the USA and the Netherlands, the quality of care for trauma patients, measured as survival, is equal. Other outcomes varied between both trauma centers, suggesting that differences in local policies and processes do influence the care system, but not so much the quality of care as reflected by survival.
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Affiliation(s)
- Suzan Dijkink
- Department of Surgery, Leiden University Medical Center, The Netherlands.
| | | | - Pieta Krijnen
- Department of Surgery, Leiden University Medical Center, The Netherlands
| | - Lisa Dol
- Department of Surgery, Leiden University Medical Center, The Netherlands
| | - Steven Rhemrev
- Department of Surgery, Haaglanden Medical Center, The Netherlands
| | - David R King
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, United States
| | - Marc A DeMoya
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, United States
| | - George C Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, United States
| | - Inger B Schipper
- Department of Surgery, Leiden University Medical Center, The Netherlands
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19
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Baek MR, Jung KT. Prediction of Changes in Health Expenditure of Chronic Diseases between Age group of Middle and Old Aged Population by using Future Elderly Model. HEALTH POLICY AND MANAGEMENT 2016. [DOI: 10.4332/kjhpa.2016.26.2.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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20
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Goldman DP, Gaudette É, Cheng WH. Competing Risks: Investing in Sickness Rather Than Health. Am J Prev Med 2016; 50:S45-S50. [PMID: 27102858 DOI: 10.1016/j.amepre.2015.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/30/2015] [Accepted: 12/14/2015] [Indexed: 01/02/2023]
Affiliation(s)
- Dana P Goldman
- Leonard D. Schaeffer for Health Policy and Economics, University of Southern California, Los Angeles, California.
| | - Étienne Gaudette
- Leonard D. Schaeffer for Health Policy and Economics, University of Southern California, Los Angeles, California
| | - Wei-Han Cheng
- Leonard D. Schaeffer for Health Policy and Economics, University of Southern California, Los Angeles, California
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21
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Wouterse B, Huisman M, Meijboom BR, Deeg DJH, Polder JJ. The effect of trends in health and longevity on health services use by older adults. BMC Health Serv Res 2015; 15:574. [PMID: 26704342 PMCID: PMC4690430 DOI: 10.1186/s12913-015-1239-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Indexed: 11/23/2022] Open
Abstract
Background The effect of population aging on future health services use depends on the relationship between longevity gains and health. Whether further gains in life expectancy will be paired by improvements in health is uncertain. We therefore analyze the effect of population ageing on health services use under different health scenarios. We focus on the possibly diverging trends between different dimensions of health and their effect on health services use. Methods Using longitudinal data on health and health services use, a latent Markov model has been estimated that includes different dimensions of health. We use this model to perform a simulation study and analyze the health dynamics that drive the effect of population aging. We simulate three health scenarios on the relationship between longevity and health (expansion of morbidity, compression of morbidity, and the dynamic equilibrium scenario). We use the scenarios to predict costs of health services use in the Netherlands between 2010 and 2050. Results Hospital use is predicted to decline after 2040, whereas long-term care will continue to rise up to 2050. Considerable differences in expenditure growth rates between scenarios with the same life expectancy but different trends in health are found. Compression of morbidity generally leads to the lowest growth. The effect of additional life expectancy gains within the same health scenario is relatively small for hospital care, but considerable for long-term care. Conclusions By comparing different health scenarios resulting in the same life expectancy, we show that health improvements do contain costs when they decrease morbidity but not mortality. This suggests that investing in healthy aging can contribute to containing health expenditure growth.
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Affiliation(s)
- Bram Wouterse
- Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands. .,Center for Public Health Forecasting, National Institute for Public Health and the Environment, Bilthoven, >The Netherlands. .,CPB Netherlands Bureau for Economic Policy Analysis, P.O. Box 80510, The Hague, 2508 GM, >The Netherlands.
| | - Martijn Huisman
- EMGO + Institute on Health and Care Research, Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, >The Netherlands. .,Department of Sociology, VU University, Amsterdam, >The Netherlands.
| | - Bert R Meijboom
- Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
| | - Dorly J H Deeg
- EMGO + Institute on Health and Care Research, Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, >The Netherlands. .,Department of Psychiatry, VU University Medical Center, Amsterdam, >The Netherlands.
| | - Johan J Polder
- Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands. .,Center for Public Health Forecasting, National Institute for Public Health and the Environment, Bilthoven, >The Netherlands.
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Affiliation(s)
| | | | | | - David Agus
- University of Southern California Keck School of Medicine and Viterbi School of Engineering, Beverly Hills, CA, USA
| | - Dana Goldman
- University of Southern California Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
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23
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Datta Gupta N, Kleinjans KJ, Larsen M. The effect of a severe health shock on work behavior: Evidence from different health care regimes. Soc Sci Med 2015; 136-137:44-51. [PMID: 25982868 DOI: 10.1016/j.socscimed.2015.05.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this paper, we use the policy variation of two different types of health insurance in the US and in Denmark - employer-provided and universal insurance combined with substantial differences in expected and actual medical out-of-pocket expenditures - to explore the effect of new severe health shocks on the labor force participation of older workers. Our results not only provide insight into how relative disease risk affects labor force participation at older ages, but also into how different types of health care and health insurance systems affect individual decisions of labor force participation. Although employer-tied health insurance and greater out-of-pocket medical expenditures give US Americans greater incentives to continue to work, we find only small differences in the work response between the two countries. We provide compelling evidence that our somewhat counterintuitive finding is the result of differential mortality and baseline health differences coupled with distinct treatment regimes under the respective health care systems.
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Affiliation(s)
| | | | - Mona Larsen
- SFI - The Danish National Center for Social Research, Denmark
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24
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Arnardottir NY, Koster A, Van Domelen DR, Brychta RJ, Caserotti P, Eiriksdottir G, Sverrisdottir JE, Launer LJ, Gudnason V, Johannsson E, Harris TB, Chen KY, Sveinsson T. Objective measurements of daily physical activity patterns and sedentary behaviour in older adults: Age, Gene/Environment Susceptibility-Reykjavik Study. Age Ageing 2013; 42:222-9. [PMID: 23117467 DOI: 10.1093/ageing/afs160] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND objectively measured population physical activity (PA) data from older persons is lacking. The aim of this study was to describe free-living PA patterns and sedentary behaviours in Icelandic older men and women using accelerometer. METHODS from April 2009 to June 2010, 579 AGESII-study participants aged 73-98 years wore an accelerometer (Actigraph GT3X) at the right hip for one complete week in the free-living settings. RESULTS in all subjects, sedentary time was the largest component of the total wear time, 75%, followed by low-light PA, 21%. Moderate-vigorous PA (MVPA) was <1%. Men had slightly higher average total PA (counts × day(-1)) than women. The women spent more time in low-light PA but less time in sedentary PA and MVPA compared with men (P < 0.001). In persons <75 years of age, 60% of men and 34% of women had at least one bout ≥10 min of MVPA, which decreased with age, with only 25% of men and 9% of women 85 years and older reaching this. CONCLUSION sedentary time is high in this Icelandic cohort, which has high life-expectancy and is living north of 60° northern latitude.
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Affiliation(s)
- Nanna Yr Arnardottir
- Research Center of Movement Science, University of Iceland, Stapi v/Hringbraut, Reykjavík 101, Iceland.
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Abstract
Affecting an estimated 12.6 million people and causing over 100,000 deaths per year, chronic obstructive pulmonary disease (COPD) exacts a heavy burden on American society. Despite knowledge of the impact of COPD on morbidity, mortality, and health care costs, little is known about the association of the disease with economic outcomes such as employment and the collection of disability. We quantify the impact of COPD on Americans aged 51 and older-in particular, their employment prospects and their likelihood of collecting federal disability benefits-by conducting longitudinal regression analysis using the Health and Retirement Study. Controlling for initial health status and a variety of sociodemographic factors, we find that COPD is associated with a decrease in the likelihood of employment of 8.6 percentage points (OR = 0.58, 95% CI 0.50-0.67), from 44% to 35%. This association rivals that of stroke and is larger than those of heart disease, cancer, hypertension, and diabetes. Furthermore, COPD is associated with a 3.9 percentage point (OR 2.52, 95% CI 2.00-3.17) increase in the likelihood of collecting Social Security Disability Insurance (SSDI), from 3.2% to 7.1%, as well as a 1.7 percentage point (OR 2.87, 95% CI 2.02-4.08) increase in the likelihood of collecting Supplemental Security Income (SSI), from 1.0% to 2.7%. The associations of COPD with SSDI and SSI are the largest of any of the conditions studied. Our results are consistent with the hypothesis that COPD imposes a substantial burden on American society by inhibiting employment and creating disability.
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