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Sack F, Irwin A, van der Zalm R, Ho L, Celermajer DJ, Celermajer DS. Healthcare-related carbon footprinting-lower impact of a coronary stenting compared to a coronary surgery pathway. Front Public Health 2024; 12:1386826. [PMID: 39234076 PMCID: PMC11371610 DOI: 10.3389/fpubh.2024.1386826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 08/01/2024] [Indexed: 09/06/2024] Open
Abstract
Healthcare is a major generator of greenhouse gases, so consideration of this contribution to climate change needs to be quantified in ways that can inform models of care. Given the availability of activity-based financial data, environmentally-extended input-output (EEIO) analysis can be employed to calculate systemic carbon footprints for healthcare activities, allowing comparison of different patient care pathways. We thus quantified and compared the carbon footprint of two common care pathways for patients with stable coronary artery disease, with similar clinical outcomes: coronary stenting and coronary artery bypass surgery (CABG). Healthcare cost data for these two pathways were disaggregated and the carbon footprint associated with this expenditure was calculated by connecting the flow of money within the economy to the greenhouse gases emitted to support the full range of associated activities. The systemic carbon footprint associated with an average stable patient CABG pathway, at a large tertiary referral hospital in Sydney, Australia in 2021-22, was 11.5 tonnes CO2-e, 4.9 times greater than the 2.4 tonnes CO2-e footprint of an average comparable stenting pathway. These data suggest that a stenting pathway for stable coronary disease should be preferred on environmental grounds and introduces EEIO analysis as a practical tool to assist in health-care related carbon footprinting.
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Affiliation(s)
- Fabian Sack
- Integrated Sustainability Analysis, School of Physics, The University of Sydney, Camperdown, NSW, Australia
| | - Amanda Irwin
- Integrated Sustainability Analysis, School of Physics, The University of Sydney, Camperdown, NSW, Australia
| | - Raymond van der Zalm
- Sydney Environment Institute, The University of Sydney Quadrangle, Camperdown, NSW, Australia
| | - Loraine Ho
- Performance Monitoring, Systems Improvement and Innovation Unit, Sydney Local Health District, Royal Prince Alfred Hospital, Stanmore, NSW, Australia
| | - Danielle J Celermajer
- Sydney Environment Institute, The University of Sydney Quadrangle, Camperdown, NSW, Australia
| | - David S Celermajer
- Faculty of Medicine and Health, Central Clinical School, Heart Research Institute, The University of Sydney, Newtown, NSW, Australia
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Kostourou S, Samiotis I, Dedeilias P, Charitos C, Papastamopoulos V, Mantas D, Psichogiou M, Samarkos M. Effect of an E-Prescription Intervention on the Adherence to Surgical Chemoprophylaxis Duration in Cardiac Surgery: A Single Centre Experience. Antibiotics (Basel) 2023; 12:1182. [PMID: 37508278 PMCID: PMC10376074 DOI: 10.3390/antibiotics12071182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
In our hospital, adherence to the guidelines for peri-operative antimicrobial prophylaxis (PAP) is suboptimal, with overly long courses being common. This practice does not offer any incremental benefit, and it only adds to the burden of antimicrobial consumption, promotes the emergence of antimicrobial resistance, and it is associated with adverse events. Our objective was to study the effect of an electronic reminder on the adherence to each element of PAP after cardiac surgery. We conducted a single center, before and after intervention, prospective cohort study from 1 June 2014 to 30 September 2017. The intervention consisted of a reminder of the hospital guidelines when ordering PAP through the hospital information system. The primary outcome was adherence to the suggested duration of PAP, while secondary outcomes included adherence to the other elements of PAP and incidence of surgical site infections (SSI). We have studied 1080 operations (400 pre-intervention and 680 post-intervention). Adherence to the appropriate duration of PAP increased significantly after the intervention [PRE 4.0% (16/399) vs. POST 15.4% (105/680), chi-square p < 0.001]; however, it remained inappropriately low. Factors associated with inappropriate duration of PAP were pre-operative hospitalization for <3 days, and duration of operation >4 h, while there were significant differences between the chief surgeons. Unexpectedly, the rate of SSIs increased significantly during the study (PRE 2.8% (11/400) vs. POST 5.9% (40/680), chi-square p < 0.019). The implemented intervention achieved a relative increase in adherence to the guideline-recommended PAP duration; however, adherence was still unacceptably low and further efforts to improve adherence are needed.
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Affiliation(s)
- Sofia Kostourou
- Infection Prevention Unit, Evaggelismos Hospital, 10676 Athens, Greece
| | - Ilias Samiotis
- Department of Cardiac Thoracic and Vascular Surgery, Evaggelismos Hospital, 10676 Athens, Greece
| | - Panagiotis Dedeilias
- Department of Cardiac Thoracic and Vascular Surgery, Evaggelismos Hospital, 10676 Athens, Greece
| | - Christos Charitos
- Department of Cardiac Thoracic and Vascular Surgery, Evaggelismos Hospital, 10676 Athens, Greece
| | | | - Dimitrios Mantas
- 2nd Propaedeutic Department of Surgery, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Mina Psichogiou
- 1st Department of Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Michael Samarkos
- 1st Department of Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Béjot Y, Soilly AL, Bardou M, Duloquin G, Pommier T, Laurent G, Cottin Y, Vadot L, Adam H, Boulin M, Giroud M. Efficiency and effectiveness of intensive multidisciplinary follow-up of patients with stroke/TIA or myocardial infarction compared to usual monitoring: protocol of a pragmatic randomised clinical trial. DiVa (Dijon vascular) study. BMJ Open 2023; 13:e070197. [PMID: 37185649 PMCID: PMC10151851 DOI: 10.1136/bmjopen-2022-070197] [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] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION The ongoing ageing population is associated with an increase in the number of patients suffering a stroke, transient ischaemic attack (TIA) or myocardial infarction (MI). In these patients, implementing secondary prevention is a critical challenge and new strategies need to be developed to close the gap between clinical practice and evidence-based recommendations. We describe the protocol of a randomised clinical trial that aims to evaluate the efficiency and effectiveness of an intensive multidisciplinary follow-up of patients compared with standard care. METHODS AND ANALYSIS The DiVa study is a randomised, prospective, controlled, multicentre trial including patients >18 years old with a first or recurrent stroke (ischaemic or haemorrhagic) or TIA, or a type I or II MI, managed in one of the participating hospitals of the study area, with a survival expectancy >12 months. Patients will be randomised with an allocation ratio of 1:1 in two parallel groups: one group assigned to a multidisciplinary, nurse-based and pharmacist-based 2-year follow-up in association with general practitioners, neurologists and cardiologists versus one group with usual follow-up. In each group for each disease (stroke/TIA or MI), 430 patients will be enrolled (total of 1720 patients) over 3 years. The primary outcome will be the incremental cost-utility ratio at 24 months between intensive and standard follow-up in a society perspective. Secondary outcomes will include the incremental cost-utility ratio at 6 and 12 months, the incremental cost-effectiveness ratio at 24 months, reduction at 6, 12 and 24 months of the rates of death, unscheduled rehospitalisation and iatrogenic complications, changes in quality of life, net budgetary impact at 5 years of the intensive follow-up on the national health insurance perspective and analysis of factors having positive or negative effects on the implementation of the project in the study area. ETHICS AND DISSEMINATION Ethical approval was obtained and all patients receive information about the study and give their consent to participate before randomisation. Results of the main trial and each of the secondary analyses will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT04188457. Registered on 6 December 2019.
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Affiliation(s)
- Yannick Béjot
- Neurology, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Anne-Laure Soilly
- Department of Clinical Research and Innovation, Clinical Research Unit-Methodological Support Network (USMR), University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Marc Bardou
- Gastroenterology, University Hospital Centre Dijon Bourgogne, Dijon, France
- CIC-Inserm 1432, University of Burgundy, Dijon, France
| | - Gauthier Duloquin
- Neurology, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Thibaut Pommier
- Cardiology, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Gabriel Laurent
- Cardiology, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Yves Cottin
- Cardiology, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Lucie Vadot
- Pharmacy, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Héloïse Adam
- Pharmacy, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Mathieu Boulin
- Pharmacy, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Maurice Giroud
- Neurology, University Hospital Centre Dijon Bourgogne, Dijon, France
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Roy K, Robinson JK. Durable Improvement in Generic and Fibroid-Specific Quality of Life in Women Treated with Transcervical Fibroid Ablation with the Sonata System After Three Years. J Gynecol Surg 2022; 38:143-147. [PMID: 35497488 PMCID: PMC9048174 DOI: 10.1089/gyn.2021.0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To determine quality-adjusted life years (QALYs) over 3 years after transcervical fibroid ablation (TFA) with the Sonata System. Methods: The SONATA trial was a prospective multicenter interventional trial that assessed the safety and efficacy of TFA for treatment of women with symptomatic uterine fibroids. Change in generic health status was assessed with the EuroQol 5-Dimension questionnaire (0–1 scale). Fibroid-specific quality of life (QOL) was measured on a 0 to 100 scale with the health-related quality of life subscale of the Uterine Fibroid Symptom and Quality-of-Life (UFS-QOL). The number of QALYs gained relative to baseline and cumulative QALYs were calculated using the area under the curve at each follow-up visit over 3 years. Results: Among 147 women receiving TFA, fibroid-specific QOL increased from 40 ± 21 at baseline to 84 ± 19 at 1 year and 83 ± 23 at 3 years (p < 0.001). Generic QOL increased from 0.72 ± 0.21 at baseline to 0.89 ± 0.12 at 1 year and 0.88 ± 0.16 at 3 years (p < 0.001). Over 3 years, TFA resulted in 1.24 ± 0.64 QALYs gained when using fibroid-specific health utility scores and 0.49 ± 0.61 QALYs gained when using generic health utility scores. Cumulative QALYs experienced at 3 years as a percentage of perfect health were 82% with fibroid-specific scores and 88% with generic health scores. Conclusions: Women treated by TFA with the Sonata System for symptomatic uterine fibroids reported durable improvements in generic and fibroid-specific QOL, as well as clinically meaningful increases in QALYs over 3 years. Clinical Trials.gov ID: NCT02228174. (J GYNECOL SURG 38:143)
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Affiliation(s)
- Kelly Roy
- Arizona Gynecology Consultants, Phoenix, Arizona, USA
| | - James K. Robinson
- MedStar Washington Hospital Center, Washington, District of Columbia, USA
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Ademi Z, Ofori-Asenso R, Zomer E, Owen A, Liew D. The cost-effectiveness of icosapent ethyl in combination with statin therapy compared with statin alone for cardiovascular risk reduction. Eur J Prev Cardiol 2021; 28:897-904. [PMID: 34298556 DOI: 10.1177/2047487319896648] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/03/2019] [Indexed: 01/28/2023]
Abstract
AIMS The aim of this study was to estimate the cost-effectiveness, from the perspective of the Australian public healthcare system, of icosapent ethyl in combination with statin therapy compared with statin alone for the prevention of cardiovascular disease. METHODS AND RESULTS A Markov model populated with data from the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial was designed to predict the effectiveness and costs of icosapent ethyl in combination with statins compared with statins alone over a 20-year time horizon. Data inputs for costs and utilities were sourced from published sources. The annual costs of icosapent ethyl were assumed to be AUD1637 (USD2907) per person. All future costs and outcomes were discounted annually by 5%. The main outcome of interest was incremental cost-effectiveness ratios in terms of cost per quality adjusted life year (QALY) gained and per year of life saved (YoLS). Over a 20-year time horizon, compared with statin alone, icosapent ethyl in combination with statin was estimated to cost an additional AUD$13,022 per person, but led to 0.338 YoLS and 0.289 QALYs gained (all discounted). These equated to incremental cost-effectiveness ratios of AUD45,036 per QALY gained and AUD38,480 per YoLS. Sub-analyses for primary and secondary prevention were AUD96,136 and AUD35,935 per QALY gained, respectively. The results were sensitive to time-horizon, age related trends and the acquisition price of icosapent ethyl. CONCLUSION Compared with statin alone, icosapent ethyl in combination with statin therapy is likely to be cost-effective in the prevention of cardiovascular disease assuming a willingness-to-pay threshold of AUD50,000 per QALY gained, especially in the secondary preventive setting.
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Affiliation(s)
- Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Richard Ofori-Asenso
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Bibi S, Khan A, Nadeem A, Mushtaq S, Khan GM. Assessment of utility values and QALYs after primary PCI with DP-Xience and BP-Biomatrix stents. PLoS One 2021; 16:e0253290. [PMID: 34138969 PMCID: PMC8211164 DOI: 10.1371/journal.pone.0253290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/02/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Primary percutaneous coronary intervention (PPCI) is the recommended treatment in ST elevated myocardial infarction (STEMI). The determination of Quality of life (QoL) for various options of coronary revascularization is important for establishment of a comprehensive care plan. Studies of QoL in interventional cardiology are scarce. Our study has compared utility scores and quality adjusted life year (QALY) of 2nd and 3rd generation drug eluting stents (DES). METHODS An observational cohort study was conducted to evaluate QoL and QALY using EQ-5D-5L questionnaire. Patients undergoing PPCI between July-Dec 2019 were evaluated after completion of one year of procedure. RESULTS Total 334 patients were evaluated, study population consisted of a greater number of males (87.13%) than females. Mean utility value was more in 3rd G Biomatrix stents; 0.829 ± 0.11 than 2nd G Xience stents; 0.794 ± 0.11 (p < 0.05). Visual analogue scale (VAS) value was also high in 3rd G DES (81.84 ± 8.29) as compared to 2nd G DES (77.81 ± 9.01); p< 0.05. A significant association was found between utility scores/VAS and age, DM, HTN, Current smoking, family history and CAD diagnosis. There was a gain of 0.035 QALY with the use of Biomatrix DES. CONCLUSION Health related quality of life (HRQOL) is a leading support in the decision making of therapeutic interventions. Our study has found that Biodegradable polymer (BP) Biomatrix DES are superior to the Durable polymer (DP) Xience DES having better QoL and QALY.
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Affiliation(s)
- Salma Bibi
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Amjad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Asif Nadeem
- Armed Forces Institute of Cardiology-National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Pakistan
| | - Saima Mushtaq
- Department of Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad, Pakistan
| | - Gul Majid Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- Islamia College University, Peshawar, Khyber Pakhtunkhwa, Pakistan
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Rezapour A, Tavakoli N, Akbari S, Hajahmadi M, Ameri H, Mohammadi R, Bagheri Faradonbeh S. Medical therapy versus percutaneous coronary intervention in ischemic heart disease: A cost-effectiveness analysis. Med J Islam Repub Iran 2020; 34:155. [PMID: 33500882 PMCID: PMC7813149 DOI: 10.47176/mjiri.34.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Ischemic heart disease is categorized into two acute and chronic groups, and its treatments include revascularization and medical therapy. The aim of this study is to evaluate the economic burden of medical therapy compared to percutaneous coronary intervention in ischemic heart disease. Methods: This study has been done in two steps. The first was a systematic review and meta-analysis to measure the effectiveness of two interventions and the second step was a cost-effectiveness analysis from the perspective of society. The data analysis included a meta-analysis and the Markov cohort simulation. RewMan v5 and tree age software were utilized. Uncertainties related to the model parameters were evaluated using one-way and two-way sensitivity analyses. Results: Regarding the effectiveness of interventions, the odd ratio of the quality of life in the medical therapy group (CI: 0.76-1.10) was 0.91 times the PCI group (p=0.34). This rate for mortality in medical therapy (CI: 0.52-9.68) was 2.23 times more than the PCI group; this result was not significant (p=0.02). In the cost-effectiveness analysis, the cost-effectiveness threshold was $ 16,482; ICER in increasing the QoL and reduction in the mortality rate was $ 25320.11 and $ 562.6691, respectively. Regarding the sensitivity analysis, the model was not sensitive in changing parameters in a specific domain. Conclusion: According to this study, PCI is more cost-effective than medical therapy in the reduction of mortality rate and in the field of increasing quality of life. MT strategy is more cost-effective than the PCI. This study considers controversies regarding the most appropriate treatment for patients with ischemic heart disease that is helpful for health policymakers, cardiologists and health managers.
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Affiliation(s)
- Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical
Sciences, Tehran, Iran
| | - Nader Tavakoli
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran,
Iran
| | - Sadaf Akbari
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran,
Iran
| | - Marjan Hajahmadi
- Department of Cardiology, Hazrat Rasoul Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran
| | - Hosein Ameri
- Department of Healthcare Management, School of Public Health, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran
| | - Reza Mohammadi
- Firouzabadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Bagheri Faradonbeh
- Health Management and Economics Research Center, Iran University of Medical
Sciences, Tehran, Iran
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Li Z, Habbous S, Thain J, Hall DE, Nagpal AD, Bagur R, Kiaii B, John-Baptiste A. Cost-Effectiveness Analysis of Frailty Assessment in Older Patients Undergoing Coronary Artery Bypass Grafting Surgery. Can J Cardiol 2020; 36:490-499. [DOI: 10.1016/j.cjca.2019.09.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/07/2019] [Accepted: 09/19/2019] [Indexed: 12/21/2022] Open
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Pačarić S, Turk T, Erić I, Orkić Ž, Petek Erić A, Milostić-Srb A, Farčić N, Barać I, Nemčić A. Assessment of the Quality of Life in Patients before and after Coronary Artery Bypass Grafting (CABG): A Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041417. [PMID: 32098322 PMCID: PMC7068373 DOI: 10.3390/ijerph17041417] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 01/21/2023]
Abstract
The aim of this study was to examine the quality of life and to report on the utility and QALY measures in patients before and after coronary artery bypass grafting (CABG); to investigate whether the SF-12 is comparable with the SF-36 for measuring health-related quality of life of patients with CABG; and to determine the impact of individual predictors on poor quality of life assessment after rehabilitation. This prospective study was conducted between January 2017 and December 2018 at the University Hospital Center Osijek, at three time points: pre-operation, 1 month after surgery, and after rehabilitation. The study was conducted with the SF-36 and SF-12 health questionnaires on 47 participants. After rehabilitation, there was a significant improvement in all domains of quality of life. The highest score was given to the change in pain (BP); mean scores were 63.8 (95% CI 56.9 to 70.6) (p = 0.001). The lowest grade (the lowest quality) after rehabilitation was in the domain of limitations due to physical difficulties (RP); arithmetic mean was 48.5 (95% CI 41 to 55.9) (p < 0.001). Quality-adjusted life-year was 0.41 (95% CI 0.38–0.44) after the CABG. The results of this study show that patients with coronary heart disease have poor quality of life before surgery. One month after the surgery, the quality of life improved, but was still inadequate. One year after surgery, satisfactory results were obtained in almost all subscales. The SF-36, SF-12, and its components, can be used effectively in patients with CABG. Age, gender, lifestyle, and risk factors in our sample of participants are not predictors of poor quality of life assessment after rehabilitation.
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Affiliation(s)
- Stana Pačarić
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (A.M.-S.); (I.B.)
| | - Tajana Turk
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia
| | - Ivan Erić
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia
| | - Želimir Orkić
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia
| | - Anamarija Petek Erić
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (A.M.-S.); (I.B.)
| | - Andrea Milostić-Srb
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (A.M.-S.); (I.B.)
| | - Nikolina Farčić
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (A.M.-S.); (I.B.)
- Correspondence: ; Tel.: +385-98-186-85-69
| | - Ivana Barać
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (A.M.-S.); (I.B.)
| | - Ana Nemčić
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
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Comparing the effectiveness of revascularization interventions with medical therapy in patients with ischemic cardiomyopathy: A systematic review and meta-analysis. Med J Islam Repub Iran 2019; 32:127. [PMID: 30815422 PMCID: PMC6387802 DOI: 10.14196/mjiri.32.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Determining the effectiveness of cardiovascular interventions plays an important role in reimbursement decisions, health care pricing, and providing clinical guidance on the use of existing clinical technologies. This study aimed to review and analyze the effectiveness of revascularization interventions (CABG and PCI) compared to medical therapy in patients with ischemic cardiomyopathy.
Methods: Different databases were searched up to December 2017. The articles were selected based on inclusion and exclusion criteria. Quality of all studies was evaluated by Jadad score and relevant checklists. The I2 test was used to test heterogeneity. Also, to integrate the results of similar studies, meta-analysis was done using STATA software.
Results: A total of 18 studies were included. Based on the random effects model, the overall results of comparing the effectiveness of revascularization interventions with medical therapy were as follow: 38.94 [95% CI: 26.95-50.94, p<0.001, I2 = 99.6%, p<0.001], [75.31, 95% CI: 74.06-76.57, p<0.001, I2= 88.8, p<0.001], and 75.76 [95% CI: 71.99-79.53, p<0.001, I2= 99.2, p<0.001] for cardiac mortality rate, quality of life, and 5-year survival, respectively. Also, in patient satisfaction index, revascularization interventions were shown to be more effective than medical therapy.
Conclusion: This study showed that revascularization interventions in all studied indices were more effective than medical therapy. Also, between revascularization interventions, PCI was more effective in cardiovascular mortality and 5-year survival than CABG in terms of quality of life. Moreover, CABG was more effective than PCI. In patient satisfaction index, the results of the 2 included studies were contradictory.
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Rodriguez AE. The ORBITA trial: Why is it not the last nail for coronary angioplasty in stable angina patients? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:80-81. [PMID: 30056021 DOI: 10.1016/j.carrev.2018.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Alfredo E Rodriguez
- Cardiac Unit, Cardiology Fellow Training Program, Otamendi Hospital, Buenos Aires School of Medicine, Buenos Aires, Argentina.
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