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Walli-Attaei M, Little M, Luengo-Fernandez R, Gray A, Torbica A, Maggioni AP, Bairami F, Huculeci R, Aboyans V, Timmis AD, Vardas P, Leal J. Health-related quality of life and healthcare costs of symptoms and cardiovascular disease events in patients with atrial fibrillation: a longitudinal analysis of 27 countries from the EURObservational Research Programme on Atrial Fibrillation general long-term registry. Europace 2024; 26:euae146. [PMID: 38807488 PMCID: PMC11164571 DOI: 10.1093/europace/euae146] [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: 03/20/2024] [Accepted: 05/14/2024] [Indexed: 05/30/2024] Open
Abstract
AIMS We examine the effects of symptoms and cardiovascular disease (CVD) events on health-related quality of life (HRQOL) and healthcare costs in a European population with atrial fibrillation (AF). METHODS AND RESULTS In the EURObservational Research Programme on AF long-term general registry, AF patients from 250 centres in 27 European countries were enrolled and followed for 2 years. We used fixed effects models to estimate the association of symptoms and CVD events on HRQOL and annual healthcare costs. We found significant decrements in HRQOL in AF patients in whom ST-segment elevation myocardial infarction (STEMI) [-0.075 (95% confidence interval -0.144, -0.006)], angina or non-ST-elevation myocardial infarction (NSTEMI) [-0.037 (-0.071, -0.003)], new-onset/worsening heart failure [-0.064 (-0.088, -0.039)], bleeding events [-0.031 (-0.059, -0.003)], thromboembolic events [-0.071 (-0.115, -0.027)], mild symptoms [0.037 (-0.048, -0.026)], or severe/disabling symptoms [-0.090 (-0.108, -0.072)] occurred during the follow-up. During follow-up, annual healthcare costs were associated with an increase of €11 718 (€8497, €14 939) in patients with STEMI, €5823 (€4757, €6889) in patients with angina/NSTEMI, €3689 (€3219, €4158) in patients with new-onset or worsening heart failure, €3792 (€3315, €4270) in patients with bleeding events, and €3182 (€2483, €3881) in patients with thromboembolic events, compared with AF patients without these events. Healthcare costs were primarily driven by inpatient costs. There were no significant differences in HRQOL or healthcare resource use between EU regions or by sex. CONCLUSION Symptoms and CVD events are associated with a high burden on AF patients and healthcare systems throughout Europe.
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Affiliation(s)
- Marjan Walli-Attaei
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mathew Little
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ramon Luengo-Fernandez
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | | | - Firoozeh Bairami
- European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | - Radu Huculeci
- European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, EpiMaCT, Inserm1094/IRD270, Limoges University, Limoges, France
| | - Adam D Timmis
- William Harvey Research Institute, Queen Mary University London, London UK
| | - Panos Vardas
- Hygeia Hospitals Group, HHG, Biomedical Research Foundation Academy of Athens (BRFAA), Athens, Greece
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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2
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Buja A, Rebba V, Montecchio L, Renzo G, Baldo V, Cocchio S, Ferri N, Migliore F, Zorzi A, Collins B, Amrouch C, De Smedt D, Kypridemos C, Petrovic M, O'Flaherty M, Lip GYH. The Cost of Atrial Fibrillation: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:527-541. [PMID: 38296049 DOI: 10.1016/j.jval.2023.12.015] [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: 05/16/2023] [Revised: 12/07/2023] [Accepted: 12/29/2023] [Indexed: 02/23/2024]
Abstract
OBJECTIVES Atrial fibrillation (AF) is the most common cardiac arrhythmia, with an increasing incidence and prevalence because of progressively aging populations. Costs related to AF are both direct and indirect. This systematic review aims to identify the main cost drivers of the illness, assess the potential economic impact resulting from changes in care strategies, and propose interventions where they are most needed. METHODS A systematic literature search of the PubMed and Scopus databases was performed to identify analytical observational studies defining the cost of illness in cases of AF. The search strategy was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 recommendations. RESULTS Of the 944 articles retrieved, 24 met the inclusion criteria. These studies were conducted in several countries. All studies calculated the direct medical costs, whereas 8 of 24 studies assessed indirect costs. The median annual direct medical cost per patient, considering all studies, was €9409 (13 333 US dollars in purchasing power parities), with a very large variability due to the heterogeneity of different analyses. Hospitalization costs are generally the main cost drivers. Comorbidities and complications, such as stroke, considerably increase the average annual direct medical cost of AF. CONCLUSIONS In most of the analyzed studies, inpatient care cost represents the main component of the mean direct medical cost per patient. Stroke and heart failure are responsible for a large share of the total costs; therefore, implementing guidelines to manage comorbidities in AF is a necessary step to improve health and mitigate healthcare costs.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Vincenzo Rebba
- Department of Economics and Management "Marco Fanno," University of Padua and Interuniversity Research Centre of Public Economics (CRIEP), Padua, Italy.
| | - Laura Montecchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Giulia Renzo
- Department of Economics and Management "Marco Fanno," University of Padua Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Silvia Cocchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Nicola Ferri
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Brendan Collins
- Department of Public Health, Policy & Systems - Institute of Population Health, University of Liverpool, England, UK
| | - Cheïma Amrouch
- Department of Internal Medicine and Paediatrics, Ghent University, Belgium; Department of Public Health and Primary Care, Ghent University, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Christodoulos Kypridemos
- Department of Public Health, Policy & Systems - Institute of Population Health, University of Liverpool, England, UK
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Ghent University, Belgium
| | - Martin O'Flaherty
- Department of Public Health, Policy & Systems - Institute of Population Health, University of Liverpool, England, UK; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, England, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, England, UK; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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3
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Vitolo M, Malavasi VL, Proietti M, Diemberger I, Fauchier L, Marin F, Nabauer M, Potpara TS, Dan GA, Kalarus Z, Tavazzi L, Maggioni AP, Lane DA, Lip GYH, Boriani G. Cardiac troponins and adverse outcomes in European patients with atrial fibrillation: A report from the ESC-EHRA EORP atrial fibrillation general long-term registry. Eur J Intern Med 2022; 99:45-56. [PMID: 35177307 DOI: 10.1016/j.ejim.2022.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cardiac troponins (cTn) have been reported to be predictors for adverse outcomes in atrial fibrillation (AF), patients, but their actual use is still unclear. AIM To assess the factors associated with cTn testing in routine practice and evaluate the association with outcomes. METHODS Patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry were stratified into 3 groups according to cTn levels as (i) cTn not tested, (ii) cTn in range (≤99th percentile), (iii) cTn elevated (>99th percentile). The composite outcome of any thromboembolism /any acute coronary syndrome/cardiovascular (CV) death, defined as Major Adverse Cardiovascular Events (MACE) and all-cause death were the main endpoints. RESULTS Among 10 445 AF patients (median age 71 years, 40.3% females) cTn were tested in 2834 (27.1%). cTn was elevated in 904/2834 (31.9%) and in-range in 1930/2834 (68.1%) patients. Female sex, in-hospital enrollment, first-detected AF, CV risk factors, history of coronary artery disease, and atypical AF symptoms were independently associated with cTn testing. Elevated cTn were independently associated with a higher risk for MACE (Model 1, hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.40-2.16, Model 2, HR 1.62, 95% CI 1.28-2.05; Model 3 HR 1.76, 95% CI 1.37-2.26) and all-cause death (Model 1, HR 1.45, 95% CI 1.21-1.74; Model 2, HR 1.36, 95% CI 1.12-1.66; Model 3, HR 1.38, 95% CI 1.12-1.71). CONCLUSIONS Elevated cTn levels were associated with an increased risk of all-cause mortality and adverse CV events. Clinical factors that might enhance the need to rule out CAD were associated with cTn testing.
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Affiliation(s)
- Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy; Liverpool Center for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo L Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy
| | - Marco Proietti
- Liverpool Center for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Igor Diemberger
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Laurent Fauchier
- Service de Cardiologie, Center Hospitalier Universitaire Trousseau, Tours, France
| | - Francisco Marin
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBERCV, Murcia, Spain
| | - Michael Nabauer
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia; Intensive Arrhythmia Care, Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Gheorghe-Andrei Dan
- Carol Davila' University of Medicine, Colentina University Hospital, Bucharest, Romania
| | - Zbigniew Kalarus
- Department of Cardiology, SMDZ in Zabrze, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Katowice, Poland
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | | | - Deirdre A Lane
- Liverpool Center for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Liverpool Center for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy.
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Alipour V, Zandian H, Yazdi-Feyzabadi V, Avesta L, Moghadam TZ. Economic burden of cardiovascular diseases before and after Iran's health transformation plan: evidence from a referral hospital of Iran. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:1. [PMID: 33390167 PMCID: PMC7778796 DOI: 10.1186/s12962-020-00250-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/13/2020] [Indexed: 01/14/2023] Open
Abstract
Background Different countries have set different policies to control and decrease the costs of cardiovascular diseases (CVDs). Iran was aiming to reduce the economic burden of different disease by a recent reform from named as health transformation plan (HTP). This study aimed to examine the economic burden of CVDs before and after of HTP. Methods This cross-sectional study was conducted on 600 patients with CVDs, who were randomly selected from a specialized cardiovascular hospital in the north-west of Iran. Direct and indirect costs of CVDs were calculated using the cost of illness and human capital approaches. Data were collected using a researcher-made checklist obtained from several sources including structured interviews, the Statistical Center of Iran, Iran’s Ministry of Cooperatives, Labor, and Social Welfare, the central bank of Iran, and the data of global burden of disease obtained from the Institute for Health Metrics and Evaluation to estimate direct and mortality costs. All costs were calculated in Iranian Rials (IRR). Results Total costs of CVDs were about 5571 and 6700 billion IRR before and after the HTP, respectively. More than 62% of the total costs of CVDs accounted for premature death before (64.89%) and after (62.01%) the HTP. The total hospitalization costs of CVDs was significantly increased after the HTP (p = 0.038). In both times, surgical services and visiting had the highest and lowest share of hospitalization costs, respectively. The OOP expenditure decreased significantly and reached from 54.2 to 36.7%. All hospitalization costs, except patients’ OOP expenditure, were significantly increased after the HTP about 1.3 times. Direct non-medical costs reached from 2.4 to 3.3 billion before and after the HTP, respectively. Conclusion Economic burden of CVDs increased in the north-west of Iran after the HTP due to the increase of all direct and indirect costs, except the OOP expenditure. Non-allocation of defined resources, which coincided with the international and national political and economic challenges in Iran, led to unsustainable resources of the HTP. So, no results of this study can be attributed solely to the HTP. Therefore, more detailed studies should be carried out on the reasons for the significant increase in CVDs costs in the region.
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Affiliation(s)
- Vahid Alipour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamed Zandian
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran. .,Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
| | - Vahid Yazdi-Feyzabadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Leili Avesta
- Department of Cardiology, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Telma Zahirian Moghadam
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
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5
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Vitolo M, Proietti M, Harrison S, Lane DA, Potpara TS, Boriani G, Lip GYH. The Euro Heart Survey and EURObservational Research Programme (EORP) in atrial fibrillation registries: contribution to epidemiology, clinical management and therapy of atrial fibrillation patients over the last 20 years. Intern Emerg Med 2020; 15:1183-1192. [PMID: 32557091 DOI: 10.1007/s11739-020-02405-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/08/2020] [Indexed: 12/17/2022]
Abstract
Management of atrial fibrillation (AF) may be challenging in clinical practice. Given the complexity of AF patients and the continuous advances in AF clinical management, there is a need for standardized programmes aimed at collecting so-called 'real-world clinical practice data' regarding the epidemiology, diagnostic/therapeutic/management practices and assessing adherence to guidelines. Over the past 20 years, the number of registries and surveys based on real-world AF patients has been dramatically increased. In Europe, based on the Euro Heart Survey (EHS) and the EURObservational Research Programme (EORP), a large series of studies based on these prospective, observational, large-scale multicentre registries on AF have been published. This narrative review gives an overview of these two projects on AF led by the European Society of Cardiology, focusing mainly on the contribution that these studies have provided to AF management and patient outcomes. Both the EHS and the EORP registries have collected a large amount of data regarding contemporary clinical practice, and despite some limitations, mainly related to their observational nature, these registries have contributed to our knowledge and clinical management of AF patients.
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Affiliation(s)
- Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Geriatric Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stephanie Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Ciminata G, Geue C, Langhorne P, Wu O. A two-part model to estimate inpatient, outpatient, prescribing and care home costs associated with atrial fibrillation in Scotland. BMJ Open 2020; 10:e028575. [PMID: 32193256 PMCID: PMC7150597 DOI: 10.1136/bmjopen-2018-028575] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to estimate global inpatient, outpatient, prescribing and care home costs for patients with atrial fibrillation using population-based, individual-level linked data. DESIGN A two-part model was employed to estimate the probability of resource utilisation and costs conditional on positive utilisation using individual-level linked data. SETTINGS Scotland, 5 years following first hospitalisation for AF between 1997 and 2015. PARTICIPANTS Patients hospitalised with a known diagnosis of AF or atrial flutter. PRIMARY AND SECONDARY OUTCOME MEASURES Inpatient, outpatient, prescribing and care home costs. RESULTS The mean annual cost for a patient with AF was estimated at £3785 (95% CI £3767 to £3804). Inpatient admissions and outpatient visits accounted for 79% and 8% of total costs, respectively; prescriptions and care home stay accounted for 7% and 6% of total costs. Inpatient cost was the main driver across all age groups. While inpatient cost contributions (~80%) were constant between 0 and 84 years, they decreased for patients over 85 years. This is offset by increasing care home cost contributions. Mean annual costs associated with AF increased significantly with increasing number of comorbidities. CONCLUSION This study used a contemporary and representative cohort, and a comprehensive approach to estimate global costs associated with AF, taking into account resource utilisation beyond hospital care. While overall costs, considerably affected by comorbidity, did not increase with increasing age, care home costs increased proportionally with age. Inpatient admission was the main contributor to the overall financial burden of AF, highlighting the need for improved mechanisms of early diagnosis to prevent hospitalisations.
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Affiliation(s)
- Giorgio Ciminata
- Health Economics and Health Technology Assessment (HEHTA), University of Glasgow, Glasgow, UK
| | - Claudia Geue
- Health Economics and Health Technology Assessment (HEHTA), University of Glasgow, Glasgow, UK
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment (HEHTA), University of Glasgow, Glasgow, UK
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7
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Rewiuk K, Wizner B, Klich-Rączka A, Więcek A, Mossakowska M, Chudek J, Szybalska A, Broczek K, Zdrojewski T, Grodzicki T. Atrial fibrillation independently linked with depression in community-dwelling older population. Results from the nationwide PolSenior project. Exp Gerontol 2018; 112:88-91. [PMID: 30219348 DOI: 10.1016/j.exger.2018.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 08/15/2018] [Accepted: 09/10/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Depression is a frequently observed comorbid condition in patients with cardiovascular diseases. In contrast to coronary heart disease and heart failure there is a limited amount of published data concerning the increased prevalence of depression among patients with atrial fibrillation (AF). Therefore, we decided to assess the prevalence of depression in Polish community-dwelling older patients with a history of AF. METHODS The data were collected as part of the nationwide PolSenior project (2007-2012). Out of 4979 individuals (age range 65-104 years), data on self-reported history of AF were available for 4677 (93.9%). Finally, 4049 participants without suspected moderate or severe dementia in Mini Mental State Examination test were assessed with the 15-item Geriatric Depression Scale (GDS), and a score of 6 points and more was regarded as suspected depression. RESULTS Mean age (±SD) of the study population was 78.1 (±8.3) years; 52% were males. The history of AF was reported by 788 (19.5%) subjects. In the univariate analysis a self-reported AF history was associated with 42% increase of suspected depression (41% vs 29%; P < 0.001). In multivariate logistic regression AF remained an independent predictor of depression (OR = 1.69; 95%CI: 1.43-2.00), stronger than heart failure, diabetes or coronary heart disease. CONCLUSIONS In community-dwelling geriatric Polish population AF is associated with higher prevalence of depression. This association is independent from the demographic factors, disabilities and comorbidities (including history of stroke).
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Affiliation(s)
- K Rewiuk
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland.
| | - B Wizner
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - A Klich-Rączka
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - A Więcek
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Silesia, Katowice, Poland
| | - M Mossakowska
- International Institute of Molecular and Cell Biology, Warsaw, Poland
| | - J Chudek
- Department of Pathophysiology, Medical University of Silesia, Katowice, Poland
| | - A Szybalska
- International Institute of Molecular and Cell Biology, Warsaw, Poland
| | - K Broczek
- Clinic of Geriatrics, Medical University of Warsaw, Warsaw, Poland
| | - T Zdrojewski
- Department of Arterial Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland
| | - T Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
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Guerra F, Brambatti M, Nieuwlaat R, Marcucci M, Dudink E, Crijns HJGM, Matassini MV, Capucci A. Symptomatic atrial fibrillation and risk of cardiovascular events: data from the Euro Heart Survey. Europace 2018; 19:1922-1929. [PMID: 29106537 DOI: 10.1093/europace/eux205] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/29/2017] [Indexed: 11/13/2022] Open
Abstract
Aims Atrial fibrillation (AF) is associated with a wide range of clinical presentations. Whether and how AF symptoms can affect prognosis is still unclear. Aims of the present analysis were to investigate potential predictors of symptomatic AF and to determine if symptoms are associated with higher incidence of cardiovascular (CV) events at 1-year follow-up. Methods and results The Euro Heart Survey on Atrial Fibrillation included 3607 consecutive patients with documented AF and available follow-up regarding symptoms status. Patients found symptomatic at baseline were classified into still symptomatic (SS group; n = 896) and asymptomatic (SA; n = 1556) at 1 year. Similarly, asymptomatic patients at baseline were classified into still asymptomatic (AA group; n = 903) and symptomatic (AS group; n = 252) at 1 year. Demographics, as well as clinical variables and medical treatments, were tested as potential predictors of symptoms persistence/development at 1-year. We also compared CV events between SS and SA groups, and AS and AA groups at 1-year follow-up. Both persistence and development of AF symptoms were associated with an increased risk of CV hospitalization, stroke, heart failure worsening, and thrombo-embolism. AF type, hypothyroidism, chronic heart failure, and chronic obstructive pulmonary disease (COPD), were independently associated with an increased risk of symptomatic status at 1-year follow-up between SS and SA groups. Conclusion Persistence or development of symptoms after medical treatment are associated with an increased risk of CV events during a 1-year follow-up. Type of AF, along with hypothyroidism, COPD and chronic heart failure are significantly associated with symptoms persistence despite medical treatment.
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Affiliation(s)
- Federico Guerra
- Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy
| | - Michela Brambatti
- Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy.,Department of Medicine, Division of Cardiology, University of California San Diego, 9444 Medical Center Dr, La Jolla, CA 92037, USA
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Maura Marcucci
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.,Department of Clinical Sciences and Community Health, University of Milan & Geriatrics, Fondazione-IRCSS Cá Granda, Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - Elton Dudink
- Department of Cardiology, Maastricht University Medical Centre, P.Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre, P.Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Maria Vittoria Matassini
- Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy
| | - Alessandro Capucci
- Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy
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Grau S, Azanza JR, Ruiz I, Vallejo C, Mensa J, Maertens J, Heinz WJ, Barrueta JA, Peral C, Mesa FJ, Barrado M, Charbonneau C, Rubio-Rodríguez D, Rubio-Terrés C. Cost-effectiveness analysis of combination antifungal therapy with voriconazole and anidulafungin versus voriconazole monotherapy for primary treatment of invasive aspergillosis in Spain. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 9:39-47. [PMID: 28115858 PMCID: PMC5221484 DOI: 10.2147/ceor.s122177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective According to a recent randomized, double-blind clinical trial comparing the combination of voriconazole and anidulafungin (VOR+ANI) with VOR monotherapy for invasive aspergillosis (IA) in patients with hematologic disease or with hematopoietic stem cell transplant, mortality was lower after 6 weeks with VOR+ANI than with VOR monotherapy in a post hoc analysis of patients with galactomannan-based IA. The objective of this study was to compare the cost-effectiveness of VOR+ANI with VOR, from the perspective of hospitals in the Spanish National Health System. Methods An economic model with deterministic and probabilistic analyses was used to determine costs per life-year gained (LYG) for VOR+ANI versus VOR in patients with galactomannan-based IA. Mortality, adverse event rates, and life expectancy were obtained from clinical trial data. The costs (in 2015 euros [€]) of the drugs and the adverse event-related costs were obtained from Spanish sources. A Tornado plot and a Monte Carlo simulation (1,000 iterations) were used to assess uncertainty of all model variables. Results According to the deterministic analysis, for each patient treated with VOR+ANI compared with VOR monotherapy, there would be a total of 0.348 LYG (2.529 vs 2.181 years, respectively) at an incremental cost of €5,493 (€17,902 vs €12,409, respectively). Consequently, the additional cost per LYG with VOR+ANI compared with VOR would be €15,785. Deterministic sensitivity analyses confirmed the robustness of these findings. In the probabilistic analysis, the cost per LYG with VOR+ANI was €15,774 (95% confidence interval: €15,763–16,692). The probability of VOR+ANI being cost-effective compared with VOR was estimated at 82.5% and 91.9%, based on local cost-effectiveness thresholds of €30,000 and €45,000, respectively. Conclusion According to the present economic study, combination therapy with VOR+ANI is cost-effective as primary therapy of IA in galactomannan-positive patients in Spain who have hematologic disease or hematopoietic stem cell transplant, compared with VOR monotherapy.
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Affiliation(s)
- Santiago Grau
- Pharmacy Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona
| | - Jose Ramon Azanza
- Clinical Pharmacology Department, Clínica Universidad de Navarra, Pamplona
| | - Isabel Ruiz
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona
| | - Carlos Vallejo
- Hematology Department, Hospital Universitario Donostia, San Sebastián
| | - Josep Mensa
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Johan Maertens
- Hematology Department, University Hospital Gasthuisberg, Leuven, Belgium
| | - Werner J Heinz
- Hematology/Oncology Department, Medizinische Klinik und Poliklinik II, Universitätsklinikum, Würzburg, Germany
| | | | - Carmen Peral
- Economics and Outcomes Research Department, Pfizer S.L.U, Alcobendas
| | | | - Miguel Barrado
- Clinical Trials Department, Trial Form Support, Madrid, Spain
| | - Claudie Charbonneau
- Pharmacoeconomics Department, Pfizer International Operations, Paris, France
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Nicholson G, Gandra SR, Halbert RJ, Richhariya A, Nordyke RJ. Patient-level costs of major cardiovascular conditions: a review of the international literature. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:495-506. [PMID: 27703385 PMCID: PMC5036826 DOI: 10.2147/ceor.s89331] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Robust cost estimates of cardiovascular (CV) events are required for assessing health care interventions aimed at reducing the economic burden of major adverse CV events. This review synthesizes international cost estimates of CV events. METHODS MEDLINE database was searched electronically for English language studies published during 2007-2012, with cost estimates for CV events of interest - unstable angina, myocardial infarction, heart failure, stroke, and CV revascularization. Included studies provided at least one estimate of patient-level direct costs in adults for any identified country. Information on study characteristics and cost estimates were collected. All costs were adjusted for inflation to 2013 values. RESULTS Across the 114 studies included, the average cost was US $6,466 for unstable angina, $11,664 for acute myocardial infarction, $11,686 for acute heart failure, $11,635 for acute ischemic stroke, $37,611 for coronary artery bypass graft, and $13,501 for percutaneous coronary intervention. The ranges for cost estimates varied widely across countries with US cost estimate being at least twice as high as European Union costs for some conditions. Few studies were found on populations outside the US and European Union. CONCLUSION This review showed wide variation in the cost of CV events within and across countries, while showcasing the continuing economic burden of CV disease. The variability in costs was primarily attributable to differences in study population, costing methodologies, and reporting differences. Reliable cost estimates for assessing economic value of interventions in CV disease are needed.
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11
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Ramuschkat M, Appelbaum S, Atzler D, Zeller T, Bauer C, Ojeda FM, Sinning CR, Hoffmann B, Lackner KJ, Böger RH, Wild PS, Münzel T, Blankenberg S, Schwedhelm E, Schnabel RB. ADMA, subclinical changes and atrial fibrillation in the general population. Int J Cardiol 2016; 203:640-6. [DOI: 10.1016/j.ijcard.2015.05.102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 05/11/2015] [Accepted: 05/17/2015] [Indexed: 10/23/2022]
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12
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Schnabel RB, Wild PS, Wilde S, Ojeda FM, Schulz A, Zeller T, Sinning CR, Kunde J, Lackner KJ, Munzel T, Blankenberg S. Multiple biomarkers and atrial fibrillation in the general population. PLoS One 2014; 9:e112486. [PMID: 25401728 PMCID: PMC4234420 DOI: 10.1371/journal.pone.0112486] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 10/16/2014] [Indexed: 01/09/2023] Open
Abstract
Background Different biological pathways have been related to atrial fibrillation (AF). Novel biomarkers capturing inflammation, oxidative stress, and neurohumoral activation have not been investigated comprehensively in AF. Methods and Results In the population-based Gutenberg Health Study (n = 5000), mean age 56±11 years, 51% males, we measured ten biomarkers representing inflammation (C-reactive protein, fibrinogen), cardiac and vascular function (midregional pro adrenomedullin [MR-proADM], midregional pro atrial natriuretic peptide [MR-proANP], N-terminal pro-B-type natriuretic peptide [Nt-proBNP], sensitive troponin I ultra [TnI ultra], copeptin, and C-terminal pro endothelin-1), and oxidative stress (glutathioneperoxidase-1, myeloperoxidase) in relation to manifest AF (n = 161 cases). Individuals with AF were older, mean age 64.9±8.3, and more often males, 71.4%. In Bonferroni-adjusted multivariable regression analyses strongest associations per standard deviation increase in biomarker concentrations were observed for the natriuretic peptides Nt-proBNP (odds ratio [OR] 2.89, 99.5% confidence interval [CI] 2.14–3.90; P<0.0001), MR-proANP (OR 2.45, 99.5% CI 1.91–3.14; P<0.0001), the vascular function marker MR-proADM (OR 1.54, 99.5% CI 1.20–1.99; P<0.0001), TnI ultra (OR 1.50, 99.5% CI 1.19–1.90; P<0.0001) and. fibrinogen (OR 1.44, 99.5% CI 1.19–1.75; P<0.0001). Based on a model comprising known clinical risk factors for AF, all biomarkers combined resulted in a net reclassification improvement of 0.665 (99.3% CI 0.441–0.888) and an integrated discrimination improvement of >13%. Conclusions In conclusion, in our large, population-based study, we identified novel biomarkers reflecting vascular function, MR-proADM, inflammation, and myocardial damage, TnI ultra, as related to AF; the strong association of natriuretic peptides was confirmed. Prospective studies need to examine whether risk prediction of AF can be enhanced beyond clinical risk factors using these biomarkers.
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Affiliation(s)
- Renate B. Schnabel
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany
- * E-mail:
| | - Philipp S. Wild
- Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
- Center of Thrombosis and Hemostasis University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Sandra Wilde
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany
| | - Francisco M. Ojeda
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany
| | - Andreas Schulz
- Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany
| | - Christoph R. Sinning
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany
| | | | - Karl J. Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Thomas Munzel
- Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany
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Arevalo-Manso JJ, Martínez-Sánchez P, Fuentes B, Ruiz-Ares G, Sanz-Cuesta BE, Prefasi D, Juarez-Martin B, Navarro-Parias A, Parrilla-Novo P, Diez-Tejedor E. Can we improve the early detection of atrial fibrillation in a stroke unit? Detection rate of a monitor with integrated detection software. Eur J Cardiovasc Nurs 2014; 15:64-71. [PMID: 25230856 DOI: 10.1177/1474515114552043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/29/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION It is unknown whether monitors that include atrial fibrillation recognition software (AF-RS) increase the rate of early atrial fibrillation (AF) detection in acute stroke. We aimed to evaluate the AF detection rate of an AF-RS monitor and compare it with standard monitoring. METHODS This was a retrospective, single-centre observational study conducted on consecutive patients with acute transient ischaemic attack or brain infarction attended in a stroke unit (SU) with six beds. Five beds had a standard monitor with a three-lead electrocardiogram (ECG)-tracing monitor that did not automatically detect AF, and one bed had a 12-lead ECG monitor with integrated AF-RS. All patients were monitored for at least 24 h and underwent a daily ECG during their stay in the SU. In case of unknown stroke aetiology, the patients underwent 24 h Holter monitoring. RESULTS A total of 76 patients were included: 59 patients in the standard monitor group and 17 patients in the AF-RS monitor group. The mean age was 72.11 (±13.09) years, and 59.2% were men. A total of 20 new cases of AF were identified. The AF-RS monitor showed a higher rate of AF detection than the standard devices (57.1% vs 7.7%, p=0.031). The AF-RS monitor showed sensitivity, specificity, positive predictive value, and negative predictive values of 57.1%, 100%, 100% and 76.9%, respectively. For the standard monitors, these values were 7.7%, 100%, 100% and 79.3%, respectively. CONCLUSION The monitor with AF-RS demonstrated a higher detection rate for AF than standard ECG monitoring in acute stroke patients in a SU.
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Affiliation(s)
- Juan Jose Arevalo-Manso
- Department of Neurology and Stroke Centre, La Paz University Hospital; IdiPAZ, Hospital La Paz Institute for Health Research; Autonomous University of Madrid, Spain
| | - Patricia Martínez-Sánchez
- Department of Neurology and Stroke Centre, La Paz University Hospital; IdiPAZ, Hospital La Paz Institute for Health Research; Autonomous University of Madrid, Spain
| | - Blanca Fuentes
- Department of Neurology and Stroke Centre, La Paz University Hospital; IdiPAZ, Hospital La Paz Institute for Health Research; Autonomous University of Madrid, Spain
| | - Gerardo Ruiz-Ares
- Department of Neurology and Stroke Centre, La Paz University Hospital; IdiPAZ, Hospital La Paz Institute for Health Research; Autonomous University of Madrid, Spain
| | - Borja Enrique Sanz-Cuesta
- Department of Neurology and Stroke Centre, La Paz University Hospital; IdiPAZ, Hospital La Paz Institute for Health Research; Autonomous University of Madrid, Spain
| | - Daniel Prefasi
- Department of Neurology and Stroke Centre, La Paz University Hospital; IdiPAZ, Hospital La Paz Institute for Health Research; Autonomous University of Madrid, Spain
| | - Belén Juarez-Martin
- Department of Neurology and Stroke Centre, La Paz University Hospital; IdiPAZ, Hospital La Paz Institute for Health Research; Autonomous University of Madrid, Spain
| | - Azahara Navarro-Parias
- Department of Neurology and Stroke Centre, La Paz University Hospital; IdiPAZ, Hospital La Paz Institute for Health Research; Autonomous University of Madrid, Spain
| | - Pilar Parrilla-Novo
- Department of Neurology and Stroke Centre, La Paz University Hospital; IdiPAZ, Hospital La Paz Institute for Health Research; Autonomous University of Madrid, Spain
| | - Exuperio Diez-Tejedor
- Department of Neurology and Stroke Centre, La Paz University Hospital; IdiPAZ, Hospital La Paz Institute for Health Research; Autonomous University of Madrid, Spain
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Becker C. Cost-of-illness studies of atrial fibrillation: methodological considerations. Expert Rev Pharmacoecon Outcomes Res 2014; 14:661-84. [DOI: 10.1586/14737167.2014.940904] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Kassianos G, Arden C, Hogan S, Baldock L, Fuat A. The non-anticoagulation costs of atrial fibrillation management: findings from an observational study in NHS Primary Care. Drugs Context 2014; 3:212254. [PMID: 24744805 PMCID: PMC3989509 DOI: 10.7573/dic.212254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 03/18/2014] [Accepted: 04/30/2013] [Indexed: 11/21/2022] Open
Abstract
Background: Atrial fibrillation (AF) management represents a significant burden on the UK NHS. Understanding this burden will be important in informing future health care planning and policy development. Aim: To describe the non-anticoagulation costs associated with AF management in routine UK clinical practice. Materials, patients and methods: A retrospective observational study of 825 patients with AF undertaken in eight UK primary care practices. Data collected from routine clinical and prescribing records of all eligible, consenting patients, for a period of up to 3 years. The first 12 weeks following diagnosis was defined as the ‘initiation phase’; the period after week 12 was defined as the ‘maintenance phase’. Results: Mean (SD) total cost of AF management was £941 (£1094) per patient in the initiation phase and £426 (£597) per patient-year in the maintenance phase. AF-related inpatient admissions contributed most to total costs; the mean (SD) total cost per patient in the initiation phase was £2285 (£900) for admitted and £278 (£252) for non-admitted patients. Mean maintenance phase costs per year were £1323 (£755) and £168 (£234), respectively, for admitted and non-admitted patients. Significant patient variables contributing to high cost in the initiation phase were hypertension and younger patient age, although only accounting for 6% of cost variability. Significant variables in the maintenance phase (18% of cost variability) were the presence of congestive heart failure, structural heart disease or diabetes and the frequency of day case admissions, ECGs and hospitalisations in the initiation phase. Conclusions: Inpatient admissions contributed most to total AF management costs. Given the burden of hospital care, future work should focus on evaluating the appropriateness and reasons for hospitalisation in patients with AF and the factors affecting length of stay, with the aim of identifying opportunities to safely reduce inpatient costs. A number of significant patient characteristics and initiation phase variables were identified, which accounted for 18% of the variability in total maintenance phase costs. However, none of these could adequately predict high maintenance phase costs.
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Efficiency of naproxen/esomeprazole in association for osteoarthrosis treatment in Spain. ACTA ACUST UNITED AC 2013; 10:210-7. [PMID: 24380809 DOI: 10.1016/j.reuma.2013.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 10/21/2013] [Accepted: 11/20/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess, from the perspective of the National Healthcare System, the efficiency of a fixed-dose combination of naproxen and esomeprazole (naproxen/esomeprazole) in the treatment of osteoarthritis (OA) compared to other NSAID, alone or in combination with a proton pump inhibitor (PPI). METHODS A Markov model was used; it included different health states defined by gastrointestinal (GI) events: dyspepsia, symptomatic or complicated ulcer; or cardiovascular (CV) events: myocardial infarction, stroke or heart failure. The model is similar to the one used by NICE in its NSAID evaluation of OA published in 2008. The total costs (€, 2012), including drug and event-related costs, and the health outcomes expressed in quality-adjusted life years (QALY) were estimated in patients with increased GI risk, aged 65 or over, for a 1-year time horizon and a 6-month treatment with celecoxib (200mg/day), celecoxib+PPI, diclofenac (150mg/day)+PPI, etoricoxib (60mg/day), etoricoxib+PPI, ibuprofen (1,800mg/day)+PPI, naproxen (1,000mg/day)+PPI or naproxen/esomeprazole (naproxen 1,000mg/esomeprazole 40mg/day). The selected PPI was omeprazole (20mg/day). RESULTS Naproxen/esomeprazole was a dominant strategy (more effective and less costly) compared to celecoxib, etoricoxib and diclofenac+PPI. Celecoxib+PPI and etoricoxib+PPI were more effective. Considering a cost-effectiveness threshold of €30,000 per additional QALY, naproxen/esomeprazole was cost-effective compared to ibuprofen+PPI and naproxen+PPI with incremental cost-effectiveness ratios (ICER) of €15,154 and €5,202 per additional QALY, respectively. CONCLUSIONS A fixed-dose combination of naproxen and esomeprazole is a cost-effective, and even dominant, alternative compared to other options in OA patients with increased GI risk.
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17
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Schnabel RB, Michal M, Wilde S, Wiltink J, Wild PS, Sinning CR, Lubos E, Ojeda FM, Zeller T, Munzel T, Blankenberg S, Beutel ME. Depression in atrial fibrillation in the general population. PLoS One 2013; 8:e79109. [PMID: 24324579 PMCID: PMC3850915 DOI: 10.1371/journal.pone.0079109] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 09/25/2013] [Indexed: 11/19/2022] Open
Abstract
Background Initial evidence suggests that depressive symptoms are more frequent in patients with atrial fibrillation. Data from the general population are limited. Methods and Results In 10,000 individuals (mean age 56±11 years, 49.4% women) of the population-based Gutenberg Health Study we assessed depression by the Patient Health Questionnaire (PHQ-9) and a history of depression in relation to manifest atrial fibrillation (n = 309 cases). The median (25th/75th percentile) PHQ-9 score of depressive symptoms was 4 (2/6) in atrial fibrillation individuals versus 3 (2/6) individuals without atrial fibrillation, . Multivariable regression analyses of the severity of depressive symptoms in relation to atrial fibrillation in cardiovascular risk factor adjusted models revealed a relation of PHQ-9 values and atrial fibrillation (odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01–1.08; P = 0.023). The association was stronger for the somatic symptom dimension of depression (OR 1.08, 95% CI 1.02–1.15; P = 0.0085) than for cognitive symptoms (OR 1.05, 95% CI 0.98–1.11; P = 0.15). Results did not change markedly after additional adjustment for heart failure, partnership status or the inflammatory biomarker C-reactive protein. Both, self-reported physical health status, very good/good versus fair/bad, (OR 0.54, 95% CI 0.41–0.70; P<0.001) and mental health status (OR 0.61 (0.46–0.82); P = 0.0012) were associated with atrial fibrillation in multivariable-adjusted models. Conclusions In a population-based sample we observed a higher burden of depressive symptoms driven by somatic symptom dimensions in individuals with atrial fibrillation. Depression was associated with a worse perception of physical or mental health status. Whether screening and treatment of depressive symptoms modulates disease progression and outcome needs to be shown.
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Affiliation(s)
- Renate B. Schnabel
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
- * E-mail:
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Sandra Wilde
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Philipp S. Wild
- Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Center of Thrombosis and Hemostasis University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Christoph R. Sinning
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Edith Lubos
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Francisco M. Ojeda
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Thomas Munzel
- Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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Kasmeridis C, Apostolakis S, Ehlers L, Rasmussen LH, Boriani G, Lip GYH. Cost effectiveness of treatments for stroke prevention in atrial fibrillation: focus on the novel oral anticoagulants. PHARMACOECONOMICS 2013; 31:971-980. [PMID: 24085625 DOI: 10.1007/s40273-013-0090-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
For more than 5 decades, the only available treatment for the prevention of atrial fibrillation (AF)-related stroke were the vitamin K antagonists. Recently, novel oral anticoagulants (NOAC) have been approved for the prevention of AF-related stroke. In the present article, the cost effectiveness of AF-related stroke-prevention strategies is reviewed. The emphasis on NOACs aims to provide an overview of their impact on health economics based on the published cost-effectiveness analyses. The available evidence suggests that the balance from the efficacy and safety point of view makes the treatment with the NOACs a cost-effective alternative to warfarin. Thus, the NOACs offer efficacy, safety and convenience, as well as cost effectiveness, for stroke prevention in AF.
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Affiliation(s)
- Charalampos Kasmeridis
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, B18 7QH, UK
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Giménez-García E, Clua-Espuny JL, Bosch-Príncep R, López-Pablo C, Lechuga-Durán I, Gallofré-López M, Panisello-Tafalla A, Lucas-Noll J, Queralt-Tomas ML. [The management of atrial fibrillation and characteristics of its current care in outpatients. AFABE observational study]. Aten Primaria 2013; 46:58-67. [PMID: 24042075 PMCID: PMC6985628 DOI: 10.1016/j.aprim.2013.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 05/22/2013] [Accepted: 06/26/2013] [Indexed: 11/25/2022] Open
Abstract
AIM To provide insights into the characteristics and management of outpatients when their atrial fibrillation (AF) was first detected: diagnosis, treatment and follow-up in the context of the public health system. DESIGN AFABE is an observational, multicentre descriptive study with retrospective data collection relating to the practice patterns, management and initial strategies of treatment of patients with diagnosed AF in the context of primary care, emergency and cardiologists of the public health system. SETTING Primary and Specialist care. Baix Ebre region. Tarragona. Spain. SUBJECTS A representative sample of 182 subjects > 60-year-old with AF who have been randomized, recruited among the registered patients with AF in 22 primary care centres in the area of the study. MESUREMENTS Demographic data, comorbidities (AF), CHA2DS2-VASc and HAS_BLED scores, and practice patterns results between Primary Care and referral services. RESULTS A total of 182 patients were included (mean age 78.5 SD:7.3 years; 50% women). Most patients (68.3% 95%CI; 60.3-76.3) had the first contact in Primary Care, of which 56.3% (95%CI; 45.2-66.0) were sent to Hospital Emergency Department where 72.7% (95%CI: 63.5-79.0) of the oral anticoagulation and 58.4% (95%CI: 49.4-66.9) of antiarrhytmic treatments were started. More than half (55.9%:95%CI; 47.2-64.7, of patients with permanent AF were followed-up by the Cardiology department. CONCLUSIONS Most patients with newly diagnosed AF made a first contact with Primary Care, but around half were sent to Hospital Emergency departments, where they were treated with an antiarrhythmic and/or oral anticoagulation.
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Affiliation(s)
| | - Josep Lluís Clua-Espuny
- Atención Primaria/Hospitalaria, Institut Català de la Salut, Gerència Territorial Terres de l'Ebre, Tortosa, España
| | - Ramón Bosch-Príncep
- Atención Primaria/Hospitalaria, Institut Català de la Salut, Gerència Territorial Terres de l'Ebre, Tortosa, España
| | | | - Iñigo Lechuga-Durán
- Atención Primaria/Hospitalaria, Institut Català de la Salut, Gerència Territorial Terres de l'Ebre, Tortosa, España
| | - Miquel Gallofré-López
- Pla Director de la Malaltia Vascular Cerebral de Catalunya, Departament de Salut Catalunya, Barcelona, España
| | - Anna Panisello-Tafalla
- Atención Primaria/Hospitalaria, Institut Català de la Salut, Gerència Territorial Terres de l'Ebre, Tortosa, España
| | - Jorgina Lucas-Noll
- Atención Primaria/Hospitalaria, Institut Català de la Salut, Gerència Territorial Terres de l'Ebre, Tortosa, España
| | - Maria Lluisa Queralt-Tomas
- Atención Primaria/Hospitalaria, Institut Català de la Salut, Gerència Territorial Terres de l'Ebre, Tortosa, España
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Clua-Espuny JL, Lechuga-Duran I, Bosch-Princep R, Roso-Llorach A, Panisello-Tafalla A, Lucas-Noll J, López-Pablo C, Queralt-Tomas L, Giménez-Garcia E, González-Rojas N, Gallofré López M. Prevalencia de la fibrilación auricular desconocida y la no tratada con anticoagulantes. Estudio AFABE. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.03.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Features and costs of patients admitted for cardiac arrhythmias in Spain. Rev Clin Esp 2013. [DOI: 10.1016/j.rceng.2013.04.002] [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]
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Prevalence of undiagnosed atrial fibrillation and of that not being treated with anticoagulant drugs: the AFABE study. ACTA ACUST UNITED AC 2013; 66:545-52. [PMID: 24776203 DOI: 10.1016/j.rec.2013.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 03/01/2013] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Atrial fibrillation constitutes a serious public health problem because it can lead to complications. Thus, the management of this arrhythmia must include not only its treatment, but antithrombotic therapy as well. The main goal is to determine the proportion of cases of undiagnosed atrial fibrillation and the proportion of patients not being treated with oral anticoagulants. METHODS A multicenter, population-based, retrospective, cross-sectional, observational study. In all, 1043 participants over 60 years of age were randomly selected to undergo an electrocardiogram in a prearranged appointment. Demographic data, CHA2DS2-VASc and HAS-BLED scores, international normalized ratio results, and reasons for not receiving oral anticoagulant therapy were recorded. RESULTS The overall prevalence of atrial fibrillation was 10.9% (95% confidence interval, 9.1%-12.8%), 20.1% of which had not been diagnosed previously. In the group with known atrial fibrillation, 23.5% of those with CHA2DS2-VASc≥2 were not receiving oral anticoagulant therapy, and 47.9% had a HAS-BLED score≥3. The odds ratio for not being treated with oral anticoagulation was 2.04 (95% confidence interval, 1.11-3.77) for women, 1.10 (95% confidence interval, 1.05-1.15) for more advanced age at diagnosis, and 8.61 (95% confidence interval 2.38-31.0) for a CHA2DS2-VASc score<2. Cognitive impairment (15.2%) was the main reason for not receiving oral anticoagulant therapy. CONCLUSIONS The prevalence of previously undiagnosed atrial fibrillation in individuals over 60 years of age is 20.1%, and 23.5% of those who have been diagnosed receive no treatment with oral anticoagulants.
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Key Words
- AF
- Anticoagulation for atrial fibrillation
- Atrial fibrillation
- CHA(2)DS(2)-VASc
- Estudio de base poblacional
- Fibrilación auricular
- HAS-BLED
- INR
- OAT
- Population-based study
- Prevalence
- Prevalencia
- Tratamiento anticoagulante
- atrial fibrillation
- congestive heart failure, hypertension, age≥75 (doubled), diabetes, stroke (doubled)-vascular disease and sex category (female)
- hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly (>65 years), drugs/alcohol concomitantly
- international normalized ratio
- oral anticoagulant therapy
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Montes-Santiago J, Rodil V, Formiga F, Cepeda JM, Urrutia A. Features and costs of patients admitted for cardiac arrhythmias in Spain. Rev Clin Esp 2013; 213:235-9. [PMID: 23561445 DOI: 10.1016/j.rce.2013.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 02/04/2013] [Accepted: 02/10/2013] [Indexed: 11/19/2022]
Abstract
AIM Cardiac rhythm alterations are a frequent cause of hospital admission. However, we do not know their characteristics and economic costs. We have analyzed the epidemiology and cost of hospitalizations due to cardiac arrhythmias in the National Health System. METHODS The characteristics and costs were reviewed in patients admitted with a principal diagnosis of cardiac arrhythmia (1997-2010;diagnosis related groups [DRG] -138 and 139 of the National Health System minimum data base set). Atrial fibrillation/flutter accounted for 65% of these DRGs. The secondary diagnoses prevalent in such DRGs were also reviewed. RESULTS Hospitalizations due to cardiac arrhythmias were approximately 26.000 per year and close to 1.6% for mortality. In 2010 there were 26.421 hospitalizations with an estimated cost of 65 million Euros. Frequent comorbidities were recorded, such as hypertension (43%), heart failure (12%) or diabetes mellitus (20%). A total of 43% were admitted to cardiology and 36% to internal medicine. CONCLUSIONS During the period 1997-2010, there was a significant annual number of hospitalizations for cardiac arrhythmias (mainly atrial fibrillation), with measurable costs, in Spain. More than one third were attended by internists.
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Affiliation(s)
- J Montes-Santiago
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Vigo, Pontevedra, Spain.
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Brüggenjürgen B, Kohler S, Ezzat N, Reinhold T, Willich SN. Cost effectiveness of antiarrhythmic medications in patients suffering from atrial fibrillation. PHARMACOECONOMICS 2013; 31:195-213. [PMID: 23444271 DOI: 10.1007/s40273-013-0028-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Atrial fibrillation (AF), a supraventricular tachycardia disorder, is the most common sustained cardiac arrhythmia affecting 1-2 % of the general population. Prevalence is highly related to age, with every fourth individual older than 40 years old developing AF during his lifetime. Due to an aging population, the prevalence of AF is estimated to at least double within the next 50 years. This article presents AF-related cost-of-illness studies and reviews 19 cost-effectiveness studies and six cost studies published roughly over the past decade, which have compared different antiarrhythmic medications for AF. A systematic literature search for studies published between June 2000 and December 2011 was conducted in PubMed using the combination of keywords ((atrial fibrillation OR atrial flutter) AND cost). Current cost-effectiveness analyses of dronedarone and the pill-in-the-pocket strategy are subject to substantial uncertainties with regard to clinical benefit. Comparing rate control with rhythm control, a cost-effectiveness advantage for rate control was shown in several but not all studies. Within antiarrhythmic drug treatments, magnesium added onto ibutilide was shown to be more cost effective than ibutilide alone. Comparing chemical and electrical cardioversion, the latter was recommended as more cost effective from the healthcare system perspective in all reviewed studies but one. Catheter ablation appeared more cost effective than antiarrhythmic drugs in the medium to long run after 3.2-63.9 years. Admissions to hospital, inpatient care and interventional procedures as well as mortality benefit are key drivers for the cost effectiveness of AF medications. No clear cost-effectiveness advantage emerged for one specific antiarrhythmic drug from the studies that compared antiarrhythmic agents. Rate control as well as catheter ablation appear more cost effective than rhythm control in the treatment of AF. Rate control treatment also seems more cost effective than electrical cardioversion in AF patients.
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Affiliation(s)
- Bernd Brüggenjürgen
- Institute for Health Economics, Steinbeis-Hochschule-Berlin, Steinbeis-Haus, Gürtelstraße 29A/30, 10247, Berlin, Germany.
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Khaykin Y, Shamiss Y. Cost of atrial fibrillation: invasive vs non-invasive management in 2012. Curr Cardiol Rev 2012; 8:368-73. [PMID: 22920478 PMCID: PMC3492820 DOI: 10.2174/157340312803760730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 05/04/2012] [Accepted: 05/05/2012] [Indexed: 01/19/2023] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It places an enormous burden on the patients, caregivers and the society at large. As a chronic illness, AF accrues significant costs related to clinical presentation, complications and loss of productivity. Novel invasive approaches to AF promise a cure in some patients and a significant reduction in AF burden in others, but are very expensive. This paper will address the cost of conventional and invasive strategies in AF care and will review the evidence on the comparative cost effectiveness of these approaches.
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Affiliation(s)
- Yaariv Khaykin
- Heart Rhythm Program, Southlake Regional Health Centre, 105-712 Davis Drive, Newmarket, Ontario, L3Y 8C3, Canada.
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LaMori JC, Mody SH, Gross HJ, daCosta DiBonaventura M, Patel AA, Schein JR, Nelson WW. Burden of comorbidities among patients with atrial fibrillation. Ther Adv Cardiovasc Dis 2012; 7:53-62. [DOI: 10.1177/1753944712464101] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: This study examined comorbidity prevalence and general medication use among individuals with atrial fibrillation in the United States to convey a more comprehensive picture of their total disease burden. Methods: This was a retrospective, observational evaluation of responses to the 2009 wave of the annual Internet-based National Health and Wellness survey, which collects health data including epidemiologic data and information on medical treatment from a representative nationwide sample of adults in the United States. Responses were assessed to determine three measures of comorbidity: mean number of comorbidities, CHADS2 score reflecting stroke risk (0–6 points; low risk: 0; moderate risk: 1; high risk: ≥2), and scores on the Charlson Comorbidity Index, which is a measure of general comorbidity reflecting presence of a wide range of comorbidities. Results: Of the overall sample, 1297 participants reported having been diagnosed with atrial fibrillation. Almost all (98%) of the predominantly male (65.1%) and older (≥65 years of age, 65.7%) population with atrial fibrillation had at least one additional comorbidity, and 90% had cardiovascular comorbidities. On the Charlson Comorbidity Index, 44.9% of the respondents had scores of 1–2 and 20.5% had scores of 3 or higher. High risk for stroke, demonstrated by a CHADS2 score of at least 2, was present in 45% and moderate risk (CHADS2 score 1) in 36%. Of the respondents with atrial fibrillation, 71% reported current use of medication to manage the condition, but only 48% of individuals at high risk for stroke reported use of anticoagulation therapy. Of those who reported having common risk factors for stroke, the majority reported receiving prescription therapy for these conditions. Conclusions: The health burden carried by patients often extends far beyond atrial fibrillation. Physicians should carefully consider comorbidities and concomitant medications when managing patients with atrial fibrillation.
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Affiliation(s)
| | | | | | | | | | | | - Winnie W. Nelson
- Janssen Scientific Affairs, LLC, 1000 US Highway 202 South, Room 3264, Raritan, NJ 08869, USA
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Cost-Effectiveness of Dronedarone in Atrial Fibrillation: Results for Canada, Italy, Sweden, and Switzerland. Clin Ther 2012; 34:1788-802. [DOI: 10.1016/j.clinthera.2012.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2012] [Indexed: 12/24/2022]
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Ahrens I, Bode C. Rivaroxaban for stroke prevention in atrial fibrillation and secondary prevention in patients with a recent acute coronary syndrome. Future Cardiol 2012; 8:533-41. [PMID: 22871192 DOI: 10.2217/fca.12.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The occurrence of disabling stroke, the major fatal consequence of atrial fibrillation, can be reduced by almost two-thirds with warfarin oral anticoagulation. Recent estimates on the prevalence of atrial fibrillation in the USA suggest that approximately 3 million people suffer from this common cardiac arrhythmia, therefore, the socioeconomic impact of adequate oral anticoagulation is enormous. Rivaroxaban, a direct orally available factor Xa inhibitor, is the first of a new class of drugs that target a central factor of the coagulation cascade upstream of thrombin. In the ROCKET AF clinical trial, rivaroxaban demonstrated noninferiority compared with warfarin for stroke prevention in patients with atrial fibrillation, while intracranial and fatal bleeding occurred less frequently with rivaroxaban treatment. Rivaroxban has recently been approved for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation by the US FDA and EMA. Very recently, rivaroxaban in addition to dual antiplatelet therapy, was shown to reduce mortality in patients with a recent acute coronary syndrome in the ATLAS ACS 2-TIMI 51 clinical trial. The clinical evaluation of rivaroxaban in cardiovascular disease and the results of the ROCKET AF study, the landmark clinical trial of rivaroxaban for stroke prevention, are discussed along with the unique pharmacological profile of rivaroxaban.
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Affiliation(s)
- Ingo Ahrens
- Clinic for Cardiology & Angiology I, University Heart Centre Freiburg – Bad Krozingen, Hugstetter Street 55, 79106 Freiburg, Germany
| | - Christoph Bode
- Clinic for Cardiology & Angiology I, University Heart Centre Freiburg – Bad Krozingen, Hugstetter Street 55, 79106 Freiburg, Germany
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Abstract
Atrial fibrillation (AF) is a complex disease with increasing prevalence in an aging population and longer survival with cardiovascular diseases. Whereas most clinical efforts have been aimed at predicting risk of AF sequelae such as stroke and heart failure, little is known on primary prevention. AF risk assessment is complicated by the existence of distinct subtypes of AF, such as lone AF or postoperative AF, in contrast to common AF in the elderly. Due to its often intermittent nature, diagnosing AF can be a challenge. Risk prediction becomes reasonable when specific interventions arise. Due to our limited understanding of AF pathophysiology and substantial lack of specific preventive strategies in the population, modification of the general cardiovascular risk profile has largely remained the only option. Initial attempts at combining established risk factors for AF such as age, sex, hypertension, body mass index, electrocardiographic characteristics, and cardiovascular disease in a risk-prediction instrument have produced a robust algorithm. However, known risk factors only explain a fraction of the population-attributable risk of AF, and the search for novel risk indicators is ongoing. More efficient monitoring for electrocardiographic precursors of AF and the field of genomics are evolving areas of AF risk factor research. A better understanding of the underlying substrate of AF will provide targets for prevention. In the future, clinical trials will be needed to establish risk categories, interventions, and their efficacy. Despite a relevant public-health impact, knowledge on risk prediction and primary prevention of AF is still limited today. There are no conflicts of interest to disclose.
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Affiliation(s)
- Renate B Schnabel
- Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Schnabel RB, Wilde S, Wild PS, Munzel T, Blankenberg S. Atrial fibrillation: its prevalence and risk factor profile in the German general population. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:293-9. [PMID: 22577476 DOI: 10.3238/arztebl.2012.0293] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 01/10/2012] [Indexed: 01/30/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is an increasingly common problem in primary care, but little is known about its prevalence and the distribution of AF risk factors in the general population. METHODS We determined the prevalence of AF and the distribution of known AF risk factors among persons participating in the population-based Gutenberg Health Study. To this end, we used interview data about the medical diagnosis of AF and electrocardiograms (ECGs) that were performed for the study in 5000 persons aged 35 to 74. The response rate was 60.4%. RESULTS There were 5000 persons in the study sample (age 52.2 ± 11 years; 50.6% were women). The prevalence of AF, weighted for the age and sex distribution of the general population, was 2.5%. AF was found to be more common in older persons, with a more pronounced increase in men: whereas its prevalence was 0.7% in 35- to 44-year-old men, the corresponding figure for the age group 65- to 74 was as high as 10.6%. Twenty five participants (15.5% of AF cases) received their initial diagnosis of AF on the basis of the study ECG. Compared to persons without AF, persons with AF were older and more commonly male, and they had a higher burden of cardiovascular risk factors. 14.3% of persons with AF had none of the well-established risk factors for AF (systolic blood pressure, antihypertensive medication, increased body-mass-index, heart failure). 42.7% of persons with AF were not taking either anticoagulants or platelet inhibitors. CONCLUSION These data indicate that the prevalence of AF in the middle-aged general population is 2.5% overall, and higher in the elderly. AF is thus a significant public health problem, and greater awareness of it is needed.
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Affiliation(s)
- Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.
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Khaykin Y, Shamiss Y. Cost considerations in the management of atrial fibrillation - impact of dronedarone. CLINICOECONOMICS AND OUTCOMES RESEARCH 2012; 4:67-78. [PMID: 22427725 PMCID: PMC3304332 DOI: 10.2147/ceor.s16675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It is associated with significant morbidity and mortality. At the societal level, AF carries an enormous cost. Strategies aimed at reducing AF morbidity and mortality and containing the associated fiscal burden are of paramount importance. This review will discuss AF treatment strategies and economics, focusing on the impact of dronedarone, a novel antiarrhythmic agent.
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Affiliation(s)
- Yaariv Khaykin
- Heart Rhythm Program, Southlake Regional Health Center, Newmarket, Ontario, Canada
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Yana Shamiss
- Heart Rhythm Program, Southlake Regional Health Center, Newmarket, Ontario, Canada
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32
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Khaykin Y. The real cost of treating atrial fibrillation. Europace 2011; 13:1215-6. [DOI: 10.1093/europace/eur281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
The costs of atrial fibrillation (AF) are linked to the general cost of managing AF patients in different health-care systems, as well as the cost of managing AF-related complications (e.g. hospitalizations and long-term complications, such as stroke). In addition, indirect medical costs, such as care for patients who do not recuperate fully from a vascular event, and non-medical costs such as loss of work force add to the costs of AF. All estimations for cost of AF and cost of AF therapy are based on assumptions and markedly influenced by these cost determinants. This urges for extreme caution not to take cost estimates at their absolute values. In fact, even relative comparisons between interventions may have different consequences in terms of direct and indirect costs in different health-care settings. While newer therapeutic options appear to increase the cost of AF management, newer antithrombotic substances and adequate rhythm control therapy also carry the promise of preventing the two major drivers of AF-related cost, hospitalizations and AF-related complications. Formal assessment of the cost of AF requires adjustment to local practice, and more data are clearly needed especially from primary care to better estimate the 'real' cost impact of AF.
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Khaykin Y, Shamiss Y. Cost of AF Ablation: Where Do We Stand? Cardiol Res Pract 2011; 2011:589781. [PMID: 21403880 PMCID: PMC3051175 DOI: 10.4061/2011/589781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 01/15/2011] [Indexed: 11/22/2022] Open
Abstract
Atrial fibrillation (AF) is a common and frequently disabling chronic condition associated with significant patient morbidity and affecting an increasing stratum of our ageing society. Direct costs related to atrial fibrillation are comprised from direct cost of medical therapy, catheter ablation, and related hospitalizations and imaging procedures, with indirect costs related to complications of the primary therapeutic strategy, management of related conditions, as well as disability and loss in quality of life related to AF. Over the last decade, catheter ablation became a promising alternative to rate and rhythm control among symptomatic AF patients. The purpose of this paper is to describe the evidence on the financial implications related to ablation based on published data and authors' experience.
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Affiliation(s)
- Yaariv Khaykin
- Heart Rhythm Program, Southlake Regional Health Centre, Newmarket, ON, Canada L3Y 8C3
| | - Yana Shamiss
- Heart Rhythm Program, Southlake Regional Health Centre, Newmarket, ON, Canada L3Y 8C3
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35
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Le Heuzey JY. Can we predict cost of care in atrial fibrillation patients? Europace 2011; 13:1-2. [DOI: 10.1093/europace/euq379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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