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Martín-Gutiérrez A, Leal-Vega L, Coco-Martín MB, Arenillas-Lara JF. A systematic review of the socioeconomic impact of mechanical thrombectomy for acute ischemic stroke. J Stroke Cerebrovasc Dis 2024:107906. [PMID: 39127180 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107906] [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: 12/07/2023] [Revised: 07/25/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Mechanical Thrombectomy (MT) is an efficacious treatment for severe acute ischemic stroke patients. However, access to MT is limited in many parts of the world, partly due to economic barriers. The purpose of this systematic review is to provide an updated frame about the socioeconomic impact of MT. METHODS To carry out this systematic review we used the PRISMA guidelines. We included scientific articles analyzing the socioeconomic impact of MT for acute ischemic stroke, in which MT was compared to best medical therapy (BMT). The online databases of Pubmed, Scopus and Web of Science were used as main sources of information. To carry out the comparative analysis, the incremental cost-effectiveness ratio (ICER) was used, relating the cost to quality-adjusted life-year (QALY). Risk of bias was assessed with the Consensus Health Economic Criteria (CHEC) and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). RESULTS Eight hundred thirty-two studies were identified in this systematic review. As a result, studies that used cost-effectiveness analysis show that MT saves costs in the long term and cost-utility analysis show that the cost per QALY is reasonable with a mean ICER value of $14242.36/QALY. CONCLUSIONS MT has a favorable socioeconomic impact, as derived from cost-effectiveness and cost-utility analyses. Therefore, public policies should encourage the implementation of MT for stroke patients around the world.
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Affiliation(s)
- Adrián Martín-Gutiérrez
- Group of Applied Clinical Neurosciences, Department of Medicine, Dermatology and Toxicology, University of Valladolid, Valladolid, Spain..
| | - Luis Leal-Vega
- Group of Applied Clinical Neurosciences, Department of Medicine, Dermatology and Toxicology, University of Valladolid, Valladolid, Spain..
| | - María Begoña Coco-Martín
- Group of Applied Clinical Neurosciences, Department of Medicine, Dermatology and Toxicology, University of Valladolid, Valladolid, Spain..
| | - Juan F Arenillas-Lara
- Group of Applied Clinical Neurosciences, Department of Medicine, Dermatology and Toxicology, University of Valladolid, Valladolid, Spain.; Stroke Unit & Stroke Program, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain..
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Hu B, Cartagena-Farias J, Brimblecombe N, Jadoolal S, Wittenberg R. Projected costs of informal care for older people in England. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:1057-1070. [PMID: 38085432 PMCID: PMC11283415 DOI: 10.1007/s10198-023-01643-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 10/20/2023] [Indexed: 07/28/2024]
Abstract
BACKGROUND Health economics research and economic evaluation have increasingly taken a societal perspective, accounting for the economic impacts of informal care. Projected economic costs of informal care help researchers and policymakers understand better the long-term consequences of policy reforms and health interventions. This study makes projections of the economic costs of informal care for older people in England. METHODS Data come from two national surveys: the English Longitudinal Study of Ageing (ELSA, N = 35,425) and the Health Survey for England (N = 17,292). We combine a Markov model with a macrosimulation model to make the projections. We explore a range of assumptions about future demographic and epidemiological trends to capture model uncertainty and take a Bayesian approach to capture parameter uncertainty. RESULTS We estimate that the economic costs of informal care were £54.2 billion in 2019, three times larger than the expenditure on formal long-term care. Those costs are projected to rise by 87% by 2039, faster than public expenditure but slower than private expenditure on formal long-term care. These results are sensitive to assumptions about future life expectancy, fertility rates, and progression of disabilities in the population. CONCLUSIONS Prevention schemes aiming to promote healthy aging and independence will be important to alleviate the costs of informal care. The government should strengthen support for informal caregivers and care recipients to ensure the adequacy of care, protect the well-being of caregivers, and prevent the costs of informal care from spilling over to other sectors of the economy.
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Affiliation(s)
- Bo Hu
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Clement's Inn, London, WC2A 2AE, UK.
| | - Javiera Cartagena-Farias
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Clement's Inn, London, WC2A 2AE, UK
| | - Nicola Brimblecombe
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Clement's Inn, London, WC2A 2AE, UK
| | - Shari Jadoolal
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Clement's Inn, London, WC2A 2AE, UK
| | - Raphael Wittenberg
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Clement's Inn, London, WC2A 2AE, UK
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Chen X, Yang L, Aslam MF, Tao J, Zhang X, Ren P, Wang Y, Chao P. Functional analysis, virtual screening, and molecular dynamics revealed potential novel drug targets and their inhibitors against cardiovascular disease in human. J Biomol Struct Dyn 2024; 42:6982-6996. [PMID: 37608602 DOI: 10.1080/07391102.2023.2239926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023]
Abstract
Cardiovascular disease (CVD) is a group of diseases, affecting the human heart and accounting for 30% of deaths worldwide. Major CVDs include heart failure, hypertension, stroke, etc. Various therapeutics are available against CVD, still there is a dire need to find out potential protein drug targets to reduce economic burden and mortality rate. Goal of the current study was to utilize sequential computational techniques to find the best cardiovascular drug targets and their inhibitors. Common human cardiovascular targets of both databases (GeneCards and Uniprot) were subjected to bioinformatics analyses. Purpose was to validate putative therapeutic targets employing the structure-based bioinformatics methods to determine their physiochemical properties and biological processes. Three stable proteins, that have 0 transmembrane helices, and possess biological processes were screened as potential protein-based therapeutic targets: Hemoglobin subunit beta (HBB), Gamma-enolase (ENO2), and Cholesteryl ester transfer protein (CETP). Tertiary structures of target proteins were retrieved from PDB, and molecular docking technique was utilized to evaluate a library of 5000 phytochemicals against the interacting residues of the target protein as well as their respective standard drugs through MOE and Pyrx software. Top five phytochemicals (d-Sesamin, 1,3-benzodioxole, Sativanone, Thiamine, and Cajanol) were identified based on their RMSD and docking scores as compared to their standard drugs. The docking studies were also validated by MM-GBSA binding free energy and molecular dynamics simulations. According to the study's findings, these phytochemicals may eventually be used as drugs to treat CVD. Further in vitro testing is required to confirm their efficacy and drug potency.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Xiaoyang Chen
- Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Lijuan Yang
- Department of Neurology, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | | | - Jing Tao
- Department of Rehabilitation, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Xueqin Zhang
- Department of Nephrology, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Peng Ren
- Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Yong Wang
- Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Peng Chao
- Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
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Hermansen AS, Joshi VL, Wagner MK, Dieperink KB, Zwisler AD, Borregaard B. Caregiver strain among relatives of out-of-hospital cardiac arrest survivors; the DANCAS relative survey. Resuscitation 2024; 201:110298. [PMID: 38950727 DOI: 10.1016/j.resuscitation.2024.110298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 06/16/2024] [Accepted: 06/24/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Knowledge about caregiver strain among relatives of out-of-hospital cardiac arrest (OHCA) survivors is limited. Thus, the objectives were to i) describe differences in self-reported mental well-being, mental health, and caregiver strain at different time points (1-5 years) post-OHCA and ii) investigate characteristics associated with caregiver strain. METHODS A national cross-sectional survey (DANCAS) from October 2020 to March 2021 with OHCA survivors and their closest relatives. The relative survey included the WHO-5 Well-being Index (WHO-5), the Hospital Anxiety and Depression Scale (HADS) and the Modified Caregiver Strain Index (M-CSI). Differences in scores between time groups were explored using descriptive statistics. Associations between characteristics and caregiver strain were investigated with multivariable logistic regression models, presented as odds ratios (OR) with 95% confidence intervals (CI), adjusted for gender, age, education status, relative affiliation, and time after OHCA. RESULTS Of 561 relatives, 24% (n = 137) experienced caregiver strain, with no significant differences in the relatives' mental well-being, mental health, or caregiver strain with time since OHCA. In the adjusted analyses, older age (OR 0.98 95% CI 0.96;0.99) and several self-reported outcomes, including reduced mental well-being (WHO-5 OR 7.27 95% CI 4.86;11.52), symptoms of anxiety (HADS-A OR 6.01 95% CI 3.89;9.29) and depression (HADS-D OR 15.03 95% CI 7.33;30.80) were significantly associated with worse caregiver strain. CONCLUSION Nearly one-quarter of relatives of OHCA survivors experience caregiver strain, with this proportion remaining unchanged with time. Several outcomes were associated with caregiver strain, emphasising the need to identify relatives at greater risk of burden following OHCA.
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Affiliation(s)
- Anne Sofie Hermansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Vicky L Joshi
- Lecturer in Physiotherapy, Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
| | - Mette Kirstine Wagner
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Karin B Dieperink
- Department of Oncology, Odense University Hospital, Odense, Denmark; FaCe, Family Focused Healthcare Research Center, University of Southern Denmark., Odense, Denmark
| | - Ann-Dorthe Zwisler
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; FaCe, Family Focused Healthcare Research Center, University of Southern Denmark., Odense, Denmark.
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Mansoor M, Shafiq MH, Khalique F. The impact of SGLT 2 inhibitors: Heart failure and beyond. Ir J Med Sci 2024; 193:1773-1774. [PMID: 38416375 DOI: 10.1007/s11845-024-03644-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Misha Mansoor
- Allama Iqbal Medical College, 164-C Faisal Town, Lahore, 54700, Pakistan.
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Joynt Maddox KE, Elkind MSV, Aparicio HJ, Commodore-Mensah Y, de Ferranti SD, Dowd WN, Hernandez AF, Khavjou O, Michos ED, Palaniappan L, Penko J, Poudel R, Roger VL, Kazi DS. Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050-Prevalence of Risk Factors and Disease: A Presidential Advisory From the American Heart Association. Circulation 2024; 150:e65-e88. [PMID: 38832505 DOI: 10.1161/cir.0000000000001256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND Cardiovascular disease and stroke are common and costly, and their prevalence is rising. Forecasts on the prevalence of risk factors and clinical events are crucial. METHODS Using the 2015 to March 2020 National Health and Nutrition Examination Survey and 2015 to 2019 Medical Expenditure Panel Survey, we estimated trends in prevalence for cardiovascular risk factors based on adverse levels of Life's Essential 8 and clinical cardiovascular disease and stroke. We projected through 2050, overall and by age and race and ethnicity, accounting for changes in disease prevalence and demographics. RESULTS We estimate that among adults, prevalence of hypertension will increase from 51.2% in 2020 to 61.0% in 2050. Diabetes (16.3% to 26.8%) and obesity (43.1% to 60.6%) will increase, whereas hypercholesterolemia will decline (45.8% to 24.0%). The prevalences of poor diet, inadequate physical activity, and smoking are estimated to improve over time, whereas inadequate sleep will worsen. Prevalences of coronary disease (7.8% to 9.2%), heart failure (2.7% to 3.8%), stroke (3.9% to 6.4%), atrial fibrillation (1.7% to 2.4%), and total cardiovascular disease (11.3% to 15.0%) will rise. Clinical CVD will affect 45 million adults, and CVD including hypertension will affect more than 184 million adults by 2050 (>61%). Similar trends are projected in children. Most adverse trends are projected to be worse among people identifying as American Indian/Alaska Native or multiracial, Black, or Hispanic. CONCLUSIONS The prevalence of many cardiovascular risk factors and most established diseases will increase over the next 30 years. Clinical and public health interventions are needed to effectively manage, stem, and even reverse these adverse trends.
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Nissen NK, Guldin MB, Nielsen CP, Ørtenblad L. Do Interventions Meet the Needs of Caregivers of Cardiac Patients?: A Scoping Review. J Cardiovasc Nurs 2024:00005082-990000000-00211. [PMID: 39039633 DOI: 10.1097/jcn.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
BACKGROUND Interventions targeting the needs of caregivers of cardiac patients are few, and in most cases, no effect is found on caregivers' well-being. A closer look at the existing interventions will provide a solid foundation for future efforts to develop effective interventions targeted at caregivers of cardiac patients. OBJECTIVE The study's objective was to scrutinize and discuss interventions targeting caregivers of cardiac patients and contribute to reflections that will improve future interventions. METHODS Systematic scoping of the literature within the field was conducted through a literature search in PubMed, EMBASE, CINAHL, PsycINFO, and Cochrane Library from January 2011 to May 2022. The development of search terms and inclusion criteria was inspired by the Patient problem/population, Intervention, Comparison/Control, and Outcome approach, and the Medical Research Council framework for developing and evaluating complex interventions served as the underlying basis for the analysis. RESULTS Eleven articles were included. The interventions reported in the articles were generally not systematically developed and did not include field-specific, methodological, and theoretical reflections. Furthermore, the development process behind the studies seemed not to be transparent. CONCLUSIONS Lack of systematic methodology and methodological transparency in the reviewed studies hinders further testing of interventions and might explain lack of evidence for effective interventions within the field. More systematic, needs-based, and well-documented interventions targeting caregivers of various kinds of cardiac patients are needed to develop the field to the benefit of caregivers, patients, and society.
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Kazi DS, Elkind MSV, Deutsch A, Dowd WN, Heidenreich P, Khavjou O, Mark D, Mussolino ME, Ovbiagele B, Patel SS, Poudel R, Weittenhiller B, Powell-Wiley TM, Joynt Maddox KE. Forecasting the Economic Burden of Cardiovascular Disease and Stroke in the United States Through 2050: A Presidential Advisory From the American Heart Association. Circulation 2024; 150:e89-e101. [PMID: 38832515 DOI: 10.1161/cir.0000000000001258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND Quantifying the economic burden of cardiovascular disease and stroke over the coming decades may inform policy, health system, and community-level interventions for prevention and treatment. METHODS We used nationally representative health, economic, and demographic data to project health care costs attributable to key cardiovascular risk factors (hypertension, diabetes, hypercholesterolemia) and conditions (coronary heart disease, stroke, heart failure, atrial fibrillation) through 2050. The human capital approach was used to estimate productivity losses from morbidity and premature mortality due to cardiovascular conditions. RESULTS One in 3 US adults received care for a cardiovascular risk factor or condition in 2020. Annual inflation-adjusted (2022 US dollars) health care costs of cardiovascular risk factors are projected to triple between 2020 and 2050, from $400 billion to $1344 billion. For cardiovascular conditions, annual health care costs are projected to almost quadruple, from $393 billion to $1490 billion, and productivity losses are projected to increase by 54%, from $234 billion to $361 billion. Stroke is projected to account for the largest absolute increase in costs. Large relative increases among the Asian American population (497%) and Hispanic American population (489%) reflect the projected increases in the size of these populations. CONCLUSIONS The economic burden of cardiovascular risk factors and overt cardiovascular disease in the United States is projected to increase substantially in the coming decades. Development and deployment of cost-effective programs and policies to promote cardiovascular health are urgently needed to rein in costs and to equitably enhance population health.
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Shin S, Park J, Choi HY, Bu Y, Lee K. Vasorelaxant and Hypotensive Effects of Galla chinensis in Rats. Int J Mol Sci 2024; 25:7962. [PMID: 39063203 PMCID: PMC11276969 DOI: 10.3390/ijms25147962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/12/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
Previous studies have revealed the medicinal and therapeutic effects of Galla chinensis. However, no studies have focused on the antihypertensive effects of G. chinensis. Therefore, we aimed to determine the vasorelaxant and hypotensive effects of G. chinensis 50% ethanolic extract (GCE). To evaluate the vascular relaxing effect of GCE, experiments were conducted using aortic segments dissected from Sprague Dawley rats. GCE showed a vasorelaxant effect via the nitric oxide/cyclic guanosine 3',5'-monophosphate pathway, inhibiting Ca2+ channels, and activating K+ channels. The hypotensive effects of GCE were evaluated in spontaneously hypertensive rats (SHRs). The SHRs were randomly divided into a control group and orally administered GCE group (100 or 300 mg/kg). The systolic and diastolic blood pressure decreased significantly by -19.47 ± 4.58% and -31.14 ± 7.66% in the GCE 100 mg/kg group, and -21.64 ± 2.40% and -31.91 ± 5.75% in the GCE 300 mg/kg group at 4 h after administration. Considering its vasorelaxant and hypotensive effects, our results indicate that GCE may be a valuable solution for the control of hypertension. However, further studies on the long-term administration and toxicity of GCE are required.
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Affiliation(s)
- Sujin Shin
- Department of Korean Medicine, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea;
| | - Junkyu Park
- Department of Science in Korean Medicine, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea;
| | - Ho-Young Choi
- Department of Herbal Pharmacology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (H.-Y.C.); (Y.B.)
| | - Youngmin Bu
- Department of Herbal Pharmacology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (H.-Y.C.); (Y.B.)
| | - Kyungjin Lee
- Department of Herbal Pharmacology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (H.-Y.C.); (Y.B.)
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Das N, Nguyen P, Ho TQA, Lee P, Robinson S, Gao L. Methods for Measuring and Valuing Informal Care: A Systematic Review and Meta-Analysis in Stroke. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02746-3. [PMID: 38977195 DOI: 10.1016/j.jval.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 05/09/2024] [Accepted: 06/30/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES To accurately capture informal care in healthcare evaluations, rigorous approaches are required to measure and value this important care component. In this systematic review and meta-analysis, we intended to summarize the current methods of measuring and valuing informal care costs in healthcare evaluations (full and partial healthcare evaluations, including cost of illness and cost analysis) in stroke. METHODS A systematic search was conducted in MEDLINE, Embase, EconLit, and CINAHL. We used EndNote 20, Research Screener, and Covidence platforms for screening and data extraction. A meta-analysis was performed on informal care hours, and a subgroup meta-analysis was conducted based on stroke severity. RESULTS A total of 31 articles were included in the qualitative synthesis. There was variation among the studies in the informal care measurement and valuation approaches. The meta-analysis of studies where data on informal care hours were available showed an estimate of informal care hours of 25.76 per week (95% CI 13.36-38.16) with a high heterogeneity (I2 = 99.97%). The overall risk of bias in the studies was assessed as low. CONCLUSIONS Standardizing the measurement and valuation of informal care costs is essential for improving the consistency and comparability of economic evaluations. Pilot studies that incorporate standardized informal care cost valuation methods can help identify any practical challenges and capture the impact of informal care more accurately.
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Affiliation(s)
- Neha Das
- Faculty of Health, School of Health & Social Development, Institute for Health Transformation, Deakin University, Melbourne Burwood Campus, Melbourne, VIC, Australia.
| | - Phuong Nguyen
- Faculty of Health, School of Health & Social Development, Institute for Health Transformation, Deakin University, Melbourne Burwood Campus, Melbourne, VIC, Australia
| | - Thi Quynh Anh Ho
- Faculty of Health, School of Health & Social Development, Institute for Health Transformation, Deakin University, Melbourne Burwood Campus, Melbourne, VIC, Australia
| | - Peter Lee
- Faculty of Health, School of Health & Social Development, Institute for Health Transformation, Deakin University, Melbourne Burwood Campus, Melbourne, VIC, Australia
| | - Suzanne Robinson
- Faculty of Health, School of Health & Social Development, Institute for Health Transformation, Deakin University, Melbourne Burwood Campus, Melbourne, VIC, Australia
| | - Lan Gao
- Faculty of Health, School of Health & Social Development, Institute for Health Transformation, Deakin University, Melbourne Burwood Campus, Melbourne, VIC, Australia
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Rahimi T, Hashemi SS, Rezaei F, Aune D. Association between health literacy and Framingham risk score. Sci Rep 2024; 14:12837. [PMID: 38834663 DOI: 10.1038/s41598-024-63607-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 05/30/2024] [Indexed: 06/06/2024] Open
Abstract
High health literacy (HL) plays a critical role in preventing or delaying the onset of cardiovascular diseases (CVDs) and can improve disease management and control. The present study aims to determine the association between HL and non-laboratory-based (office-based) Framingham 10-year risk score of CVD. This cross-sectional study was conducted on 648 people aged 30-65 in the health centers of Jahrom. The Health Literacy Instrument for Adults (HELIA) was used to assess HL. The non-laboratory-based Framingham risk score (FRS) was utilized to determine the 10-year risk of CVDs. Risk factors such as age, gender, diabetes, current smoking status, systolic blood pressure (SBP), hypertension (HTN) treatment, and body mass index (BMI) were applied in the non-laboratory-based model. The average age of the subjects was 44.7 ± 10.5 years, among which 49.2% were males. The prevalence of diabetes, HTN, and smoking equaled 8.5%, 15.7%, and 10%, respectively. In addition, the average BMI was 26.1 ± 3.6 kg/m2. Based on the non-laboratory-based Framingham 10-year risk score of CVD, 72.5%, 13.9%, and 13.6% of the subjects were in the low, moderate, and high risk groups, respectively. Based on the HL grouping, the levels of insufficient, borderline, sufficient, and excellent HL were 19.3%, 26.4%, 34.6%, and 19.7%, respectively. A significant association was observed between 10-year CVD risk and HL grouping. In addition, a negative correlation was reported at the individual level between HL and non-laboratory-based FRS among the whole population (r = - 0.39, p < 0.001), men (r = - 0.32, p < 0.001), and women (r = - 0.42, p < 0.001). A higher HL score is associated with a lower risk of CVD. In addition, the adjusted logistic regression analysis showed that there was a strong association between elevated CVD risk (≥ 10%) and HL (OR 6.1, 95% CI 2.9-12.6) among inadequate HL participants compared with excellent HL individuals. Thus, designing and implementing training programs to increase HL, especially among those who are at risk of CVDs, should be regarded as an important issue for the prevention of such diseases.
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Affiliation(s)
- Tahereh Rahimi
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | | | - Fatemeh Rezaei
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran.
- Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom, Iran.
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Oslo New University College, Oslo, Norway
- Department of Research, The Cancer Registry of Norway, Oslo, Norway
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Dieperink KB, Møller JJK, Mikkelsen TB, Nissen NK, La Cour K, Rottmann N. The Danish landscape of providing support for caregivers of people with potentially life-threatening disease: A cross-sectional study among representatives of health services in Danish municipalities and hospitals. Scand J Public Health 2024; 52:494-501. [PMID: 37026179 DOI: 10.1177/14034948231159464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
AIMS (a) To investigate support for caregivers of people diagnosed with stroke, cancer, chronic obstructive pulmonary disease (COPD), dementia, or heart disease provided across healthcare settings in Denmark; (b) to assess differences in caregiver support across diagnoses and settings. METHODS A cross-sectional nationwide survey among professionals representing healthcare settings at municipalities (n = 479) and hospital wards and outpatient clinics (n = 425). The survey assessed identification of caregivers and support initiatives. RESULTS The response rate was 81% for municipalities and 49% for hospitals. Identification of caregivers was frequent in dementia care (81% and 100%) and less frequent in COPD care (58% and 64%) in municipalities and hospitals, respectively. Caregiver support differed significantly across diagnoses within municipalities (p = 0.009) and hospitals (p < 0.001). Systematic identification of vulnerable caregivers was <25% for all diagnoses except dementia. The most common support initiatives involving caregivers were primarily aimed at the ill person and included guidance about the disease and consequences for everyday life and lifestyle changes. Caregivers were least involved in support initiatives addressing physical training, work retention, sexuality, or cohabitation. CONCLUSIONS Disparities and significant differences across diagnoses exist in the identification of caregivers and the provision of support initiatives. Support initiatives involving caregivers primarily targeted patients. Future studies should investigate how caregivers' needs can be met across different diagnoses and healthcare settings and investigate potential changes in caregivers' needs during disease trajectories. In clinical practice, identification of vulnerable caregivers should be a major focus, and disease-specific clinical guidelines may be required to ensure sufficient support for caregivers.
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Affiliation(s)
- Karin B Dieperink
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Denmark
- Family focused healthcare Research (FaCe), University of Southern Denmark, Nyborg, Denmark
| | - Jens-Jakob K Møller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
| | - Tina B Mikkelsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
| | - Nina Konstantin Nissen
- DEFACTUM - Social & Health Services and Labour Market, Central Denmark Region, Odense, Denmark
| | - Karen La Cour
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Public Health, Research Unit for User involvement and Community-Based Interventions, University of Southern Denmark, Odense, Denmark
| | - Nina Rottmann
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Psychology, University of Southern Denmark, Denmark
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13
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Liaqat M, Mushtaq M, Jamil A, Mushtaq MM, Ali H, Anwar R, Raza A, Aslam A, Tariq T, Hussain M, Bakht D, Bokhari SFH. Mobile Health Interventions: A Frontier for Mitigating the Global Burden of Cardiovascular Disease. Cureus 2024; 16:e62157. [PMID: 38993461 PMCID: PMC11238762 DOI: 10.7759/cureus.62157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/13/2024] Open
Abstract
Mobile health (mHealth) interventions have emerged as a promising approach for cardiovascular disease (CVD) prevention and management. The proliferation of smartphones and wearable devices enables convenient access to health monitoring tools, educational resources, and communication with healthcare providers. mHealth interventions encompass mobile apps, wearables, and telehealth services that empower users to monitor vital signs, adhere to medication, and adopt healthier lifestyles. Their effectiveness hinges on user engagement, leveraging behavioral science principles and gamification strategies. While mHealth offers advantages such as personalized support and increased reach, it faces challenges pertaining to data privacy, security concerns, and resistance from healthcare providers. Robust encryption and adherence to regulations like the Health Insurance Portability and Accountability Act (HIPAA) are crucial for safeguarding sensitive health data. Integrating mHealth into clinical workflows can enhance healthcare delivery, but organizational adjustments are necessary. The future of mHealth is closely intertwined with artificial intelligence (AI), enabling remote monitoring, predictive algorithms, and data-driven insights. Tech giants are incorporating advanced health-tracking capabilities into their devices, paving the way for personalized wellness approaches. However, mHealth grapples with ethical dilemmas surrounding data ownership, privacy breaches, and inadvertent data capture. Despite its potential, mHealth necessitates a concerted effort to overcome obstacles and ensure ethical, secure, and practical implementation. Addressing technical challenges, fostering standardization, and promoting equitable access are pivotal for unlocking the transformative impact of mHealth on cardiovascular health and reducing the global burden of CVD.
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Affiliation(s)
- Maryyam Liaqat
- Internal Medicine, King Edward Medical University, Lahore, PAK
| | - Maham Mushtaq
- Medicine and Surgery, King Edward Medical University, Lahore, PAK
| | - Ahmed Jamil
- Internal Medicine, Mayo Hospital, Lahore, PAK
| | | | - Husnain Ali
- Medicine and Surgery, King Edward Medical University, Lahore, PAK
| | - Rahma Anwar
- Medicine and Surgery, King Edward Medical University, Lahore, PAK
| | - Ahmad Raza
- Internal Medicine, King Edward Medical University, Lahore, PAK
| | - Asma Aslam
- Medicine and Surgery, Karachi Medical and Dental College, Karachi, PAK
| | - Tamseer Tariq
- Medicine and Surgery, Karachi Medical and Dental College, Karachi, PAK
| | | | - Danyal Bakht
- Medicine and Surgery, Mayo Hospital, Lahore, PAK
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14
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Rinaldi AEM, Nucci LB, Enes CC. Modeling the potential impact of a sugar-sweetened beverage tax on ischemic heart disease and stroke in Brazil. J Public Health (Oxf) 2024:fdae074. [PMID: 38798018 DOI: 10.1093/pubmed/fdae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/25/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND A high intake of sugar-sweetened beverages (SSBs) is associated with the risk of several chronic diseases, including ischemic heart disease (IHD) and stroke. This study aimed to model the impact of a 20% tax on all SSBs for IHD and stroke among Brazilian adults. METHODS This was an ex-ante risk comparative study. The model applied a 20% tax on SSBs and projected the incidence, prevalence and mortality of IHD and stroke over a 20-year period (2019-39). Using data on consumption, previously published cross- and own-price elasticities of SSBs, and relative risk, we estimated changes in IHD and stroke burden. RESULTS Our model predicts that a 20% SSB tax may reduce new cases of IHD by ~13%, especially among women, and avert ~8% of the deaths attributable to IHD over 20 years. These results represent a decrease of 19 543 new cases and 8466 and 7274 fewer deaths in the period for men and women, respectively. Estimates of reduction in incidence, prevalence and deaths from stroke were not significant over 20 years. CONCLUSIONS Even under conservative assumptions, our study found that a small reduction in SSB consumption led to a substantial decrease in IHD incidence and mortality in Brazil.
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Affiliation(s)
- Ana Elisa M Rinaldi
- School of Medicine, Postgraduate Program in Health Sciences, Federal University of Uberlândia (FAMED-UFU), 1720, Pará Avenue, Block 2U, Uberlândia, MG 38400-902, Brazil
| | - Luciana Bertoldi Nucci
- School of Life Sciences, Postgraduate Program in Health Sciences, Pontifical Catholic University of Campinas (PUC-Campinas), Av. John Boyd Dunlop (no number), Campinas, SP 13060-904, Brazil
| | - Carla Cristina Enes
- School of Life Sciences, Postgraduate Program in Health Sciences, Pontifical Catholic University of Campinas (PUC-Campinas), Av. John Boyd Dunlop (no number), Campinas, SP 13060-904, Brazil
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15
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Carvalho F, Lahlou RA, Silva LR. Phenolic Compounds from Cherries and Berries for Chronic Disease Management and Cardiovascular Risk Reduction. Nutrients 2024; 16:1597. [PMID: 38892529 PMCID: PMC11174419 DOI: 10.3390/nu16111597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/15/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Cardiovascular diseases (CVDs) are a leading cause of mortality worldwide. Therefore, there is increasing interest in dietary interventions to reduce risk factors associated with these conditions. Cherries and berries are rich sources of bioactive compounds and have attracted attention for their potential cardiovascular benefits. This review summarises the current research on the effects of cherry and berry consumption on cardiovascular health, including in vivo studies and clinical trials. These red fruits are rich in phenolic compounds, such as anthocyanins and flavonoids, which have multiple bioactive properties. These properties include antioxidant, anti-inflammatory, and vasodilatory effects. Studies suggest that regular consumption of these fruits may reduce inflammation and oxidative stress, leading to lower blood pressure, improved lipid profiles, and enhanced endothelial function. However, interpreting findings and establishing optimal dosages is a challenge due to the variability in fruit composition, processing methods, and study design. Despite these limitations, the evidence highlights the potential of cherries and berries as components of preventive strategies against CVD. Further research is needed to maximise their health benefits and improve clinical practice.
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Affiliation(s)
- Filomena Carvalho
- SPRINT—Sport Physical Activity and Health Research & Innovation Center, Instituto Politécnico da Guarda, 6300-559 Guarda, Portugal; (F.C.); (R.A.L.)
| | - Radhia Aitfella Lahlou
- SPRINT—Sport Physical Activity and Health Research & Innovation Center, Instituto Politécnico da Guarda, 6300-559 Guarda, Portugal; (F.C.); (R.A.L.)
| | - Luís R. Silva
- SPRINT—Sport Physical Activity and Health Research & Innovation Center, Instituto Politécnico da Guarda, 6300-559 Guarda, Portugal; (F.C.); (R.A.L.)
- CICS-UBI—Health Sciences Research Center, University of Beira Interior, 6201-506 Covilhã, Portugal
- CERES, Department of Chemical Engineering, University of Coimbra, 3030-790 Coimbra, Portugal
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16
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Brown SD, Klimi E, Bakker WAM, Beqqali A, Baker AH. Non-coding RNAs to treat vascular smooth muscle cell dysfunction. Br J Pharmacol 2024. [PMID: 38773733 DOI: 10.1111/bph.16409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/19/2024] [Accepted: 03/14/2024] [Indexed: 05/24/2024] Open
Abstract
Vascular smooth muscle cell (vSMC) dysfunction is a critical contributor to cardiovascular diseases, including atherosclerosis, restenosis and vein graft failure. Recent advances have unveiled a fascinating range of non-coding RNAs (ncRNAs) that play a pivotal role in regulating vSMC function. This review aims to provide an in-depth analysis of the mechanisms underlying vSMC dysfunction and the therapeutic potential of various ncRNAs in mitigating this dysfunction, either preventing or reversing it. We explore the intricate interplay of microRNAs, long-non-coding RNAs and circular RNAs, shedding light on their roles in regulating key signalling pathways associated with vSMC dysfunction. We also discuss the prospects and challenges associated with developing ncRNA-based therapies for this prevalent type of cardiovascular pathology.
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Affiliation(s)
- Simon D Brown
- BHF Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Eftychia Klimi
- BHF Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Abdelaziz Beqqali
- BHF Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew H Baker
- BHF Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
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17
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Xin Y, Zhang Z, Lv S, Xu S, Liu A, Li H, Li P, Han H, Liu Y. Elucidating VSMC phenotypic transition mechanisms to bridge insights into cardiovascular disease implications. Front Cardiovasc Med 2024; 11:1400780. [PMID: 38803664 PMCID: PMC11128571 DOI: 10.3389/fcvm.2024.1400780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
Cardiovascular diseases (CVD) are the leading cause of death worldwide, despite advances in understanding cardiovascular health. Significant barriers still exist in effectively preventing and managing these diseases. Vascular smooth muscle cells (VSMCs) are crucial for maintaining vascular integrity and can switch between contractile and synthetic functions in response to stimuli such as hypoxia and inflammation. These transformations play a pivotal role in the progression of cardiovascular diseases, facilitating vascular modifications and disease advancement. This article synthesizes the current understanding of the mechanisms and signaling pathways regulating VSMC phenotypic transitions, highlighting their potential as therapeutic targets in cardiovascular disease interventions.
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Affiliation(s)
- Yuning Xin
- Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Zipei Zhang
- Traditional Chinese Medicine, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Shan Lv
- Traditional Chinese Medicine, The Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Shan Xu
- Traditional Chinese Medicine, The Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Aidong Liu
- Traditional Chinese Medicine, The Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Hongyu Li
- Traditional Chinese Medicine, The Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Pengfei Li
- Traditional Chinese Medicine, The Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Huize Han
- Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Yinghui Liu
- Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
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18
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Elkhoury K, Kodeih S, Enciso-Martínez E, Maziz A, Bergaud C. Advancing Cardiomyocyte Maturation: Current Strategies and Promising Conductive Polymer-Based Approaches. Adv Healthc Mater 2024; 13:e2303288. [PMID: 38349615 DOI: 10.1002/adhm.202303288] [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: 09/27/2023] [Revised: 01/31/2024] [Indexed: 02/21/2024]
Abstract
Cardiovascular diseases are a leading cause of mortality and pose a significant burden on healthcare systems worldwide. Despite remarkable progress in medical research, the development of effective cardiovascular drugs has been hindered by high failure rates and escalating costs. One contributing factor is the limited availability of mature cardiomyocytes (CMs) for accurate disease modeling and drug screening. Human induced pluripotent stem cell-derived CMs offer a promising source of CMs; however, their immature phenotype presents challenges in translational applications. This review focuses on the road to achieving mature CMs by summarizing the major differences between immature and mature CMs, discussing the importance of adult-like CMs for drug discovery, highlighting the limitations of current strategies, and exploring potential solutions using electro-mechano active polymer-based scaffolds based on conductive polymers. However, critical considerations such as the trade-off between 3D systems and nutrient exchange, biocompatibility, degradation, cell adhesion, longevity, and integration into wider systems must be carefully evaluated. Continued advancements in these areas will contribute to a better understanding of cardiac diseases, improved drug discovery, and the development of personalized treatment strategies for patients with cardiovascular disorders.
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Affiliation(s)
- Kamil Elkhoury
- LAAS-CNRS, Université de Toulouse, CNRS, Toulouse, F-31400, France
| | - Sacha Kodeih
- Faculty of Medicine and Medical Sciences, University of Balamand, Tripoli, P.O. Box 100, Lebanon
| | | | - Ali Maziz
- LAAS-CNRS, Université de Toulouse, CNRS, Toulouse, F-31400, France
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19
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Chuzi S, Manning K. Integration of palliative care across the spectrum of heart failure care and therapies: considerations, contemporary data, and challenges. Curr Opin Cardiol 2024; 39:218-225. [PMID: 38567949 DOI: 10.1097/hco.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW Heart failure (HF) is characterized by significant symptoms, compromised quality of life, frequent hospital admissions, and high mortality, and is therefore well suited to palliative care (PC) intervention. This review elaborates the current PC needs of patients with HF across the spectrum of disease, including patients who undergo advanced HF surgical therapies, and reviews the current data and future directions for PC integration in HF care. RECENT FINDINGS Patients with chronic HF, as well as those who are being evaluated for or who have undergone advanced HF surgical therapies such as left ventricular assist device or heart transplantation, have a number of PC needs, including decision-making, symptoms and quality of life, caregiver support, and end-of-life care. Available data primarily supports the use of PC interventions in chronic HF to improve quality of life and symptoms. PC skills and teams may also help address preparedness planning, adverse events, and psychosocial barriers in patients who have had HF surgeries, but more data are needed to determine association with outcomes. SUMMARY Patients with HF have tremendous PC needs across the spectrum of disease. Despite this, more data are needed to determine the optimal timing and structure of PC interventions in patients with chronic HF, left ventricular assist device, and heart transplantation. Future steps must be taken in clinical, research, and policy domains in order to optimize care.
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Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katharine Manning
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center
- Section of Palliative Medicine, Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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20
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Neri M, Mewes JC, de Almeida FA, Stoychev S, Minarovic N, Charos A, Shea KM, Steuten LMG. Impact of including productivity costs in economic analyses of vaccines for C. difficile infections and infant respiratory syncytial virus, in a UK setting. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:34. [PMID: 38689331 PMCID: PMC11059668 DOI: 10.1186/s12962-024-00533-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/21/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES It has been estimated that vaccines can accrue a relatively large part of their value from patient and carer productivity. Yet, productivity value is not commonly or consistently considered in health economic evaluations of vaccines in several high-income countries. To contribute to a better understanding of the potential impact of including productivity value on the expected cost-effectiveness of vaccination, we illustrate the extent to which the incremental costs would change with and without productivity value incorporated. METHODS For two vaccines currently under development, one against Cloistridioides difficile (C. difficile) infection and one against respiratory syncytial disease (RSV), we estimated their incremental costs with and without productivity value included and compared the results. RESULTS In this analysis, reflecting a UK context, a C. difficile vaccination programme would prevent £12.3 in productivity costs for every person vaccinated. An RSV vaccination programme would prevent £49 in productivity costs for every vaccinated person. CONCLUSIONS Considering productivity costs in future cost-effectiveness analyses of vaccines for C. difficile and RSV will contribute to better-informed reimbursement decisions from a societal perspective.
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21
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Wechsler PM, Pandya A, Parikh NS, Razzak JA, White H, Navi BB, Kamel H, Liberman AL. Cost-Effectiveness of Increased Use of Dual Antiplatelet Therapy After High-Risk Transient Ischemic Attack or Minor Stroke. J Am Heart Assoc 2024; 13:e032808. [PMID: 38533952 PMCID: PMC11179775 DOI: 10.1161/jaha.123.032808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/14/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Rates of dual antiplatelet therapy (DAPT) after high-risk transient ischemic attack or minor ischemic stroke (TIAMIS) are suboptimal. We performed a cost-effectiveness analysis to characterize the parameters of a quality improvement (QI) intervention designed to increase DAPT use after TIAMIS. METHODS AND RESULTS We constructed a decision tree model that compared current national rates of DAPT use after TIAMIS with rates after implementing a theoretical QI intervention designed to increase appropriate DAPT use. The base case assumed that a QI intervention increased the rate of DAPT use to 65% from 45%. Costs (payer and societal) and outcomes (stroke, myocardial infarction, major bleed, or death) were modeled using a lifetime horizon. An incremental cost-effectiveness ratio <$100 000 per quality-adjusted life year was considered cost-effective. Deterministic and probabilistic sensitivity analyses were performed. From the payer perspective, a QI intervention was associated with $9657 in lifetime cost savings and 0.18 more quality-adjusted life years compared with current national treatment rates. A QI intervention was cost-effective in 73% of probabilistic sensitivity analysis iterations. Results were similar from the societal perspective. The maximum acceptable, initial, 1-time payer cost of a QI intervention was $28 032 per patient. A QI intervention that increased DAPT use to at least 51% was cost-effective in the base case. CONCLUSIONS Increasing DAPT use after TIAMIS with a QI intervention is cost-effective over a wide range of costs and proportion of patients with TIAMIS treated with DAPT after implementation of a QI intervention. Our results support the development of future interventions focused on increasing DAPT use after TIAMIS.
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Affiliation(s)
- Paul M. Wechsler
- Department of Neurology, Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNY
| | - Ankur Pandya
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMA
| | - Neal S. Parikh
- Department of Neurology, Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNY
| | - Junaid A. Razzak
- Department of Emergency MedicineWeill Cornell MedicineNew YorkNY
| | - Halina White
- Department of Neurology, Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNY
| | - Babak B. Navi
- Department of Neurology, Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNY
| | - Hooman Kamel
- Department of Neurology, Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNY
| | - Ava L. Liberman
- Department of Neurology, Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNY
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22
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Komura T, Tsugawa Y, Kondo N, Inoue K. Depression Onset After a Spouse's Cardiovascular Event. JAMA Netw Open 2024; 7:e244602. [PMID: 38607629 PMCID: PMC11015352 DOI: 10.1001/jamanetworkopen.2024.4602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/31/2024] [Indexed: 04/13/2024] Open
Abstract
Importance Although cardiovascular disease (CVD) is a known risk factor for depression, evidence is lacking regarding whether and to what extent a spouse's CVD is associated with the subsequent mental health of individuals. Objective To examine the association between CVD onset in spouses and subsequent depression. Design, Setting, and Participants This cohort study examined 277 142 matched married couples enrolled in the Japan Health Insurance Association health insurance program between April 2015 and March 2022, covering approximately 40% of the working-age population in Japan. Index individuals (primary insured) whose spouses (dependent) experienced incident CVD between April 2016 and March 2022 were 1:1 matched to controls whose spouses did not experience CVD. Matching was based on age, sex, income, or the onset date of the spouses' CVD. Data analysis was conducted from April 2016 to March 2022. Exposure Spousal onset of CVD between fiscal years 2016 and 2021. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes were used to identify the composite CVD outcomes (stroke, heart failure, and myocardial infarction). Main Outcomes and Measures Multivariate Cox proportional hazards models were used to investigate the association between spouses' new-onset CVD and individuals' depression, adjusting for sociodemographic characteristics and comorbidities of index individuals (diabetes, hypertension, and CVD) and spouses (diabetes, hypertension, and depression). Subgroup analyses were conducted according to sex, age, income levels, and history of CVD. Results Among 277 142 matched pairs of married couples, 263 610 (95.1%) had a male index individual; the mean (SD) age of index individuals was 58.2 (10.2) years. A new onset of depression was observed in 4876 individuals (1.8%). In multivariable Cox models, there was an association between the spouse's CVD and the individuals' depression (hazard ratio, 1.13 [95% CI, 1.07-1.20]). The subgroup analysis found no evidence of heterogeneity in sex, age, income level, or CVD history. The results were consistent when additionally adjusted for health behaviors (smoking, alcohol consumption, physical activity, and use of antihypertensive drugs) and objectively measured physical health conditions (body mass index, blood pressure, cholesterol levels, glucose levels, and estimated glomerular filtration rate) (hazard ratio, 1.16 [95% CI, 1.06-1.28]). Conclusions and Relevance In this nationwide cohort study of matched couples, a spouse's onset of CVD was associated with an increased risk of an individual's depression. These findings highlight the importance of preventive care for mental health disorders in individuals whose spouses experience incident CVD.
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Affiliation(s)
- Toshiaki Komura
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Hakubi Center for Advanced Research, Kyoto University, Kyoto, Japan
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23
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Ramadani RV, Svensson M, Hassler S, Hidayat B, Ng N. The impact of multimorbidity among adults with cardiovascular diseases on healthcare costs in Indonesia: a multilevel analysis. BMC Public Health 2024; 24:816. [PMID: 38491478 PMCID: PMC10941372 DOI: 10.1186/s12889-024-18301-7] [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: 07/30/2023] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are the leading cause of death in Indonesia, accounting for 38% of the total mortality in 2019. Moreover, healthcare spending on CVDs has been at the top of the spending under the National Health Insurance (NHI) implementation. This study analyzed the association between the presence of CVDs with or without other chronic disease comorbidities and healthcare costs among adults (> 30 years old) and if the association differed between NHI members in the subsidized group (poorer) and non-subsidized households group (better-off) in Indonesia. METHODS This retrospective cohort study analyzed the NHI database from 2016-2018 for individuals with chronic diseases (n = 271,065) ascertained based on ICD-10 codes. The outcome was measured as healthcare costs in USD value for 2018. We employed a three-level multilevel linear regression, with individuals at the first level, households at the second level, and districts at the third level. The outcome of healthcare costs was transformed with an inverse hyperbolic sine to account for observations with zero costs and skewed data. We conducted a cross-level interaction analysis to analyze if the association between individuals with different diagnosis groups and healthcare costs differed between those who lived in subsidized and non-subsidized households. RESULTS The mean healthcare out- and inpatient costs were higher among patients diagnosed with CVDs and multimorbidity than patients with other diagnosis groups. The predicted mean outpatient costs for patients with CVDs and multimorbidity were more than double compared to those with CVDs but no comorbidity (USD 119.5 vs USD 49.1, respectively for non-subsidized households and USD 79.9 vs USD 36.7, respectively for subsidized households). The NHI household subsidy status modified relationship between group of diagnosis and healthcare costs which indicated a weaker effect in the subsidized household group (β = -0.24, 95% CI -0.29, -0.19 for outpatient costs in patients with CVDs and multimorbidity). At the household level, higher out- and inpatient costs were associated with the number of household members with multimorbidity. At the district level, higher healthcare costs was associated with the availability of primary healthcare centres. CONCLUSIONS CVDs and multimorbidity are associated with higher healthcare costs, and the association is stronger in non-subsidized NHI households. Households' subsidy status can be construed as indirect socioeconomic inequality that hampers access to healthcare facilities. Efforts to combat cardiovascular diseases (CVDs) and multimorbidity should consider their distinct impacts on subsidized households. The effort includes affirmative action on non-communicable disease (NCD) management programs that target subsidized households from the early stage of the disease.
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Affiliation(s)
- Royasia Viki Ramadani
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Center for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Kota Depok, Indonesia.
| | - Mikael Svensson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, USA
| | - Sven Hassler
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Budi Hidayat
- Center for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Kota Depok, Indonesia
| | - Nawi Ng
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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24
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Jiang M, Ren X, Han L, Zheng X. Associations between sarcopenic obesity and risk of cardiovascular disease: A population-based cohort study among middle-aged and older adults using the CHARLS. Clin Nutr 2024; 43:796-802. [PMID: 38350287 DOI: 10.1016/j.clnu.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/08/2024] [Accepted: 02/02/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Previous studies have demonstrated that sarcopenia was associated with a high risk of cardiovascular disease (CVD). Nevertheless, little is known about the associations between sarcopenic obesity/possibly sarcopenic obesity and the risk of CVD among senior and middle-aged adults. METHODS Utilizing the nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS), a sum of 7703 individuals aged at least 45 years were divided into four groups. The effects of sarcopenic obesity and possibly sarcopenic obesity on CVD were calculated using Cox proportional hazards regression models. Non-sarcopenic participants with optimal body mass index (BMI) or waist circumference (WC) served as a control group. RESULTS Sarcopenic obesity were related to increased risks of CVD (HR = 1.39; 95% CI = 1.16-1.67), heart disease (HR = 1.36; 95% CI = 1.10-1.67) and stroke (HR = 1.40; 95% CI = 1.02-1.92) compared with the optimal reference group. Similarly, the risk of CVD, heart disease and stroke increased by 0.34, 0.28 and 0.39 times in obese people with possible sarcopenia compared to the control group. Sensitivity analysis identified similar results to those described above. Patients with sarcopenia and a BMI ≥28.0 kg/m2 had a 1.47- and 1.48-fold risk of developing CVD and heart disease than controls. CONCLUSION Sarcopenic obesity and possibly sarcopenic obesity are positively associated with the development of CVD. The middle-aged and elderly population should prevent obesity and maintain muscle mass through some interventions such as weight control and moderate exercise, which may reduce the CVD risk.
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Affiliation(s)
- Minglan Jiang
- Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, 214122, China
| | - Xiao Ren
- Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, 214122, China
| | - Longyang Han
- Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, 214122, China
| | - Xiaowei Zheng
- Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, 214122, China.
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Sheikh AM, Yano S, Tabassum S, Nagai A. The Role of the Vascular System in Degenerative Diseases: Mechanisms and Implications. Int J Mol Sci 2024; 25:2169. [PMID: 38396849 PMCID: PMC10889477 DOI: 10.3390/ijms25042169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Degenerative diseases, encompassing a wide range of conditions affecting various organ systems, pose significant challenges to global healthcare systems. This comprehensive review explores the intricate interplay between the vascular system and degenerative diseases, shedding light on the underlying mechanisms and profound implications for disease progression and management. The pivotal role of the vascular system in maintaining tissue homeostasis is highlighted, as it serves as the conduit for oxygen, nutrients, and immune cells to vital organs and tissues. Due to the vital role of the vascular system in maintaining homeostasis, its dysfunction, characterized by impaired blood flow, endothelial dysfunction, and vascular inflammation, emerges as a common denominator of degenerative diseases across multiple systems. In the nervous system, we explored the influence of vascular factors on neurodegenerative diseases such as Alzheimer's and Parkinson's, emphasizing the critical role of cerebral blood flow regulation and the blood-brain barrier. Within the kidney system, the intricate relationship between vascular health and chronic kidney disease is scrutinized, unraveling the mechanisms by which hypertension and other vascular factors contribute to renal dysfunction. Throughout this review, we emphasize the clinical significance of understanding vascular involvement in degenerative diseases and potential therapeutic interventions targeting vascular health, highlighting emerging treatments and prevention strategies. In conclusion, a profound appreciation of the role of the vascular system in degenerative diseases is essential for advancing our understanding of degenerative disease pathogenesis and developing innovative approaches for prevention and treatment. This review provides a comprehensive foundation for researchers, clinicians, and policymakers seeking to address the intricate relationship between vascular health and degenerative diseases in pursuit of improved patient outcomes and enhanced public health.
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Affiliation(s)
- Abdullah Md. Sheikh
- Department of Laboratory Medicine, Faculty of Medicine, Shimane University, 89-1 Enya Cho, Izumo 693-8501, Japan; (S.Y.); (S.T.); (A.N.)
| | - Shozo Yano
- Department of Laboratory Medicine, Faculty of Medicine, Shimane University, 89-1 Enya Cho, Izumo 693-8501, Japan; (S.Y.); (S.T.); (A.N.)
| | - Shatera Tabassum
- Department of Laboratory Medicine, Faculty of Medicine, Shimane University, 89-1 Enya Cho, Izumo 693-8501, Japan; (S.Y.); (S.T.); (A.N.)
| | - Atsushi Nagai
- Department of Laboratory Medicine, Faculty of Medicine, Shimane University, 89-1 Enya Cho, Izumo 693-8501, Japan; (S.Y.); (S.T.); (A.N.)
- Department of Neurology, Faculty of Medicine, Shimane University, 89-1 Enya Cho, Izumo 693-8501, Japan
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Ramadani RV, Svensson M, Hassler S, Hidayat B, Ng N. Effects of the COVID-19 pandemic on healthcare utilization among older adults with cardiovascular diseases and multimorbidity in Indonesia: an interrupted time-series analysis. BMC Public Health 2024; 24:71. [PMID: 38166721 PMCID: PMC10763491 DOI: 10.1186/s12889-023-17568-6] [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: 07/18/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted healthcare utilization globally, but little is known about the effects among patients with cardiovascular diseases (CVDs) and other multimorbidities. This study analyzed the impacts of COVID-19 on healthcare utilization for patients aged 30 years and older with cardiovascular diseases (CVDs) with or without other chronic disease comorbidities in Indonesia. METHODS We designed a retrospective cohort study based on the Indonesian National Health Insurance (NHI) sample data from 2016-2020. We defined healthcare utilization as monthly outpatient and inpatient visits related to chronic diseases at the hospital and primary healthcare levels per 10,000 NHI members. We used interrupted time series analysis to evaluate how the healthcare utilization patterns had changed due to the COVID-19 pandemic. RESULTS Overall, hospital outpatient visits decreased by 39% when the pandemic occurred (95% Confidence Interval (CI): 0.48,0.76), inpatient visits by 28% (95% CI: 0.62,0.83), and primary healthcare visits by 34% (95% CI:0.55, 0.81). For patients with CVDs and multimorbidity, hospital outpatient and inpatient visit rates were reduced by 36% and 38%, respectively and primary healthcare visits by 32%. Some insignificant differences in the reduction of out-and inpatient visits were observed across diagnosis groups and regions. CONCLUSION Healthcare utilization among patients with chronic diseases decreased significantly during COVID-19 and consistently across different chronic diseases and regions. To cope with the unmet needs of healthcare utilization in the context of the pandemic, the healthcare system needs to be strengthened to cater to the needs of the population-at-risk, especially for patients with CVDs and multimorbidity.
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Affiliation(s)
- Royasia Viki Ramadani
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Center for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia.
| | - Mikael Svensson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, USA
| | - Sven Hassler
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Budi Hidayat
- Center for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia
| | - Nawi Ng
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Amin N, Devasia T, Kamath SU, Paramasivam G, Shetty PN, Singh A, Prakash GNS. Confounding Factors Responsible for Elevated Lp(a) Levels in Patients with Coronary Artery Disease. Ann Card Anaesth 2024; 27:32-36. [PMID: 38722118 PMCID: PMC10876127 DOI: 10.4103/aca.aca_88_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/24/2023] [Accepted: 09/29/2023] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are a leading cause of global mortality, motivating research into novel approaches for their management. Lipoprotein(a) (Lp(a)), a unique lipoprotein particle, has been implicated in atherosclerosis and thrombosis, suggesting its potential as a therapeutic target for CVDs. AIM This study aimed to investigate the association of Lp(a) levels with various cardiovascular parameters and events among patients with confirmed cardiovascular disease. METHODOLOGY A prospective study was conducted, enrolling 600 participants, predominantly comprising males (79%), with a mean age of 52.78 ± 0.412 years diagnosed with cardiovascular disease. The follow-up was done for 18 months. Patient demographics, blood investigations, and occurrence of major adverse cardiac events (MACE) were collected. SPSS version 21 was used to statistically analyze the relationships between elevated Lp(a) levels and factors such as age, glycated hemoglobin, mortality, MACE, cardiac death, target vessel revascularization, and stroke. RESULTS The study revealed significant (P < 0.05) associations between elevated Lp(a) levels and advanced age, increased glycated hemoglobin levels, as well as occurrences of all-cause mortality, MACE, cardiac death, target vessel revascularization, and stroke. Notably, a significant (P < 0.05), association between high Lp(a) levels and acute coronary syndrome (ACS) emerged, suggesting Lp(a)'s role in advanced cardiac events. CONCLUSION The findings highlight the potential significance of Lp(a) as a notable risk factor in cardiovascular health. The observed associations between elevated Lp(a) and adverse cardiovascular events, including ACS, underscore its pathogenic role. Consequently, this study supports the rationale for further research into Lp(a)-specific therapeutic interventions, offering substantial promise in refining the management strategies for cardiovascular diseases.
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Affiliation(s)
- Navaneeth Amin
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Tom Devasia
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shobha Ullas Kamath
- Department of Biochemistry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ganesh Paramasivam
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Prasad Narayana Shetty
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ajit Singh
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ganesha N. S. Prakash
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Rivera FB, Choi S, Carado GP, Adizas AV, Bantayan NRB, Loyola GJP, Cha SW, Aparece JP, Rocha AJB, Placino S, Ansay MFM, Mangubat GFE, Mahilum MLP, Al-Abcha A, Suleman N, Shah N, Suboc TMB, Volgman AS. End-Of-Life Care for Patients With End-Stage Heart Failure, Comparisons of International Guidelines. Am J Hosp Palliat Care 2024; 41:87-98. [PMID: 36705612 DOI: 10.1177/10499091231154575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Heart failure (HF) is a chronic, debilitating condition associated with significant morbidity, mortality, and socioeconomic burden. Patients with end-stage HF (ESHF) who are not a candidate for advanced therapies will continue to progress despite standard medical therapy. Thus, the focus of care shifts from prolonging life to controlling symptoms and improving quality of life through palliative care (PC). Because the condition and prognosis of HF patients evolve and can rapidly deteriorate, it is imperative to begin the discussion on end-of-life (EOL) issues early during HF management. These include the completion of an advance directive, do-not-resuscitate orders, and policies on device therapy and discontinuation as part of advance care planning (ACP). ESHF patients who do not have indications for advanced therapies or those who wish not to have a left ventricular assist device (LVAD) or heart transplant (HT) often experience high symptom burden despite adequate medical management. The proper identification and assessment of symptoms such as pain, dyspnea, nausea, depression, and anxiety are essential to the management of ESHF and may be underdiagnosed and undertreated. Psychological support and spiritual care are also crucial to improving the quality of life during EOL. Caregivers of ESHF patients must also be provided supportive care to prevent compassion fatigue and improve resilience in patient care. In this narrative review, we compare the international guidelines and provide an overview of end-of-life and palliative care for patients with ESHF.
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Affiliation(s)
| | - Sarang Choi
- Ateneo de Manila School of Medicine and Public Health, Pasig City, Philippines
| | - Genquen Philip Carado
- University of the East Ramon Magsaysay Memorial Medical Center, Inc, Quezon City, Philippines
| | - Arcel V Adizas
- University of the Philippines-Philippine General Hospital, Manila, Philippines
| | | | | | | | | | | | - Siena Placino
- St Luke's Medical Center College of Medicine, William H. Quasha Memorial, Manila, Philippines
| | | | | | | | - Abdullah Al-Abcha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Natasha Suleman
- Department of Palliative Care, Lincoln Medical Center, Bronx, NY, USA
| | - Nishant Shah
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
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Bonanad C, Buades JM, Leiva JP, De la Espriella R, Marcos MC, Núñez J, García-Llana H, Facila L, Sánchez R, Rodríguez-Osorio L, Alonso-Babarro A, Quiroga B, Bompart Berroteran D, Rodríguez C, Maidana D, Díez J. Consensus document on palliative care in cardiorenal patients. Front Cardiovasc Med 2023; 10:1225823. [PMID: 38179502 PMCID: PMC10766370 DOI: 10.3389/fcvm.2023.1225823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/06/2023] [Indexed: 01/06/2024] Open
Abstract
There is an unmet need to create consensus documents on the management of cardiorenal patients since, due to the aging of the population and the rise of both pathologies, these patients are becoming more prevalent in daily clinical practice. Chronic kidney disease coexists in up to 40%-50% of patients with chronic heart failure cases. There have yet to be consensus documents on how to approach palliative care in cardiorenal patients. There are guidelines for patients with heart failure and chronic kidney disease separately, but they do not specifically address patients with concomitant heart failure and kidney disease. For this reason, our document includes experts from different specialties, who will not only address the justification of palliative care in cardiorenal patients but also how to identify this patient profile, the shared planning of their care, as well as knowledge of their trajectory and the palliative patient management both in the drugs that will help us control symptoms and in advanced measures. Dialysis and its different types will also be addressed, as palliative measures and when the decision to continue or not perform them could be considered. Finally, the psychosocial approach and adapted pharmacotherapy will be discussed.
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Affiliation(s)
- Clara Bonanad
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Biomedical Research Institute (INCLIVA), Valencia, Spain
- Center for Network Biomedical Research of Cardiovascular Diseases (CIBERCV), Carlos III Institute of Health, Madrid, Spain
| | - Juan M. Buades
- Nephrology Department, Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain
- Institute for Health Research of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Juan Pablo Leiva
- Support and Palliative Care Team, Hospital Manacor, Palma de Mallorca, Spain
| | - Rafael De la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Biomedical Research Institute (INCLIVA), Valencia, Spain
- Center for Network Biomedical Research of Cardiovascular Diseases (CIBERCV), Carlos III Institute of Health, Madrid, Spain
| | - Marta Cobo Marcos
- Center for Network Biomedical Research of Cardiovascular Diseases (CIBERCV), Carlos III Institute of Health, Madrid, Spain
- Cardiology Department, Hospital Puerta del Hierro, Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Biomedical Research Institute (INCLIVA), Valencia, Spain
- Center for Network Biomedical Research of Cardiovascular Diseases (CIBERCV), Carlos III Institute of Health, Madrid, Spain
| | - Helena García-Llana
- Universidad Internacional de La Rioja (UNIR), La Rioja, Spain
- Centro de Estudios Superiores Cardenal Cisneros, Universidad Pontifica de Comillas, Madrid, Spain
| | - Lorenzo Facila
- Cardiology Department, Consorcio Hospital General de Valencia, Valencia, Spain
| | - Rosa Sánchez
- Nephrology Department, Hospital Universitario General de Villalba, Madrid, Spain
| | | | | | - Borja Quiroga
- Cardiology Department, Consorcio Hospital General de Valencia, Valencia, Spain
| | | | - Carmen Rodríguez
- Nephrology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Javier Díez
- Center for Network Biomedical Research of Cardiovascular Diseases (CIBERCV), Carlos III Institute of Health, Madrid, Spain
- Center for Applied Medical Research (CIMA), and School of Medicine, Universidad de Navarra, Pamplona, Spain
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Kumari V, Kumar N, Kumar K S, Kumar A, Skandha SS, Saxena S, Khanna NN, Laird JR, Singh N, Fouda MM, Saba L, Singh R, Suri JS. Deep Learning Paradigm and Its Bias for Coronary Artery Wall Segmentation in Intravascular Ultrasound Scans: A Closer Look. J Cardiovasc Dev Dis 2023; 10:485. [PMID: 38132653 PMCID: PMC10743870 DOI: 10.3390/jcdd10120485] [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: 07/27/2023] [Revised: 10/15/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND AND MOTIVATION Coronary artery disease (CAD) has the highest mortality rate; therefore, its diagnosis is vital. Intravascular ultrasound (IVUS) is a high-resolution imaging solution that can image coronary arteries, but the diagnosis software via wall segmentation and quantification has been evolving. In this study, a deep learning (DL) paradigm was explored along with its bias. METHODS Using a PRISMA model, 145 best UNet-based and non-UNet-based methods for wall segmentation were selected and analyzed for their characteristics and scientific and clinical validation. This study computed the coronary wall thickness by estimating the inner and outer borders of the coronary artery IVUS cross-sectional scans. Further, the review explored the bias in the DL system for the first time when it comes to wall segmentation in IVUS scans. Three bias methods, namely (i) ranking, (ii) radial, and (iii) regional area, were applied and compared using a Venn diagram. Finally, the study presented explainable AI (XAI) paradigms in the DL framework. FINDINGS AND CONCLUSIONS UNet provides a powerful paradigm for the segmentation of coronary walls in IVUS scans due to its ability to extract automated features at different scales in encoders, reconstruct the segmented image using decoders, and embed the variants in skip connections. Most of the research was hampered by a lack of motivation for XAI and pruned AI (PAI) models. None of the UNet models met the criteria for bias-free design. For clinical assessment and settings, it is necessary to move from a paper-to-practice approach.
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Affiliation(s)
- Vandana Kumari
- School of Computer Science and Engineering, Galgotias University, Greater Noida 201310, India; (V.K.); (S.K.K.)
| | - Naresh Kumar
- Department of Applied Computational Science and Engineering, G L Bajaj Institute of Technology and Management, Greater Noida 201310, India
| | - Sampath Kumar K
- School of Computer Science and Engineering, Galgotias University, Greater Noida 201310, India; (V.K.); (S.K.K.)
| | - Ashish Kumar
- School of CSET, Bennett University, Greater Noida 201310, India;
| | - Sanagala S. Skandha
- Department of CSE, CMR College of Engineering and Technology, Hyderabad 501401, India;
| | - Sanjay Saxena
- Department of Computer Science and Engineering, IIT Bhubaneswar, Bhubaneswar 751003, India;
| | - Narendra N. Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi 110076, India;
| | - John R. Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA 94574, USA;
| | - Narpinder Singh
- Department of Food Science and Technology, Graphic Era, Deemed to be University, Dehradun 248002, India;
| | - Mostafa M. Fouda
- Department of Electrical and Computer Engineering, Idaho State University, Pocatello, ID 83209, USA;
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), 09100 Cagliari, Italy;
| | - Rajesh Singh
- Department of Research and Innovation, Uttaranchal Institute of Technology, Uttaranchal University, Dehradun 248007, India;
| | - Jasjit S. Suri
- Stroke Diagnostics and Monitoring Division, AtheroPoint™, Roseville, CA 95661, USA
- Department of Computer Science & Engineering, Graphic Era, Deemed to be University, Dehradun 248002, India
- Monitoring and Diagnosis Division, AtheroPoint™, Roseville, CA 95661, USA
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Ye F, Lee JJ, Xue D, Yu DSF. Acceptance and Commitment Therapy Among Informal Caregivers of People With Chronic Health Conditions: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2346216. [PMID: 38051530 DOI: 10.1001/jamanetworkopen.2023.46216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Importance Although there is substantial evidence to suggest the health benefits of acceptance and commitment therapy (ACT) among informal caregivers of people with chronic health conditions, the great variation in intervention designs among published studies limits its application. Objectives To identify intervention characteristics of ACT that are associated with improved psychological health and to assess the acceptability of ACT among informal caregivers. Data Sources Seven English- and 3 Chinese-language databases without limits on publication dates, the reference lists of previous reviews, and gray literature were searched up to February 2023. Study Selection Randomized clinical trials comparing the effect of ACT vs control groups on improving psychological health among informal caregivers. Data Extraction and Synthesis Two reviewers independently screened searched records and extracted data from eligible studies. Random-effects meta-analysis and mixed-effects metaregression were performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. Main Outcomes and Measures Psychological health outcomes (eg, depressive symptoms) measured by valid measurements and the acceptability of ACT based on identified parameters. Results A total of 29 studies with 2010 participants, published between 2015 and 2023, were identified. ACT showed moderate to large effect sizes for improving psychological health at postintervention assessments (Hedges g range, -0.55 [95% CI, -0.98 to -0.12] to -1.14 [95% CI, -1.83 to -0.45]) and at 1-to-3-month and 4-to-6-month follow-ups (Hedges g range, -0.47 [95% CI, -0.69 to -0.25] to -1.29 [95% CI, -2.33 to -0.24]). Multivariable metaregression analysis regarding intervention characteristics found that ACT delivered in a mixed individual- and group-based format, face-to-face, or through more intervention sessions was associated with greater improvements for experiential avoidance (face-to-face: β = -1.170 [95% CI, -2.020 to -0.319]; number of sessions: β = -0.242 [95% CI, -0.353 to -0.130]), depressive symptoms (mixed delivery format: β = -2.583 [95% CI, -4.845 to -0.321]; face-to-face: β = -1.555 [95% CI, -3.002 to -0.108]), or anxiety symptoms (face-to-face: β = -1.241 [95% CI, -2.337 to -0.146]). In general, ACT had low attrition rates (11%), and participants' adherence (51%-80%) and satisfactory ratings (72%-95%) lend support to its acceptability. Conclusions and Relevance This systematic review and meta-analysis found that ACT was consistently associated with improvements in psychological health, supporting its application to improve informal care for chronic disease management. This review provides specific details on the design parameters of ACT for achieving greater efficacy.
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Affiliation(s)
- Fen Ye
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jung Jae Lee
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Dandan Xue
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Doris Sau-Fung Yu
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Zhang X, Zhao Q, Wang T, Long Q, Sun Y, Jiao L, Gullerova M. DNA damage response, a double-edged sword for vascular aging. Ageing Res Rev 2023; 92:102137. [PMID: 38007046 DOI: 10.1016/j.arr.2023.102137] [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: 04/14/2023] [Revised: 10/03/2023] [Accepted: 11/20/2023] [Indexed: 11/27/2023]
Abstract
Vascular aging is a major risk factor for age-related cardiovascular diseases, which have high rates of morbidity and mortality. It is characterized by changes in the blood vessels, such as macroscopically increased vascular diameter and intima-medial thickness, chronic inflammation, vascular calcification, arterial stiffening, and atherosclerosis. DNA damage and the subsequent various DNA damage response (DDR) pathways are important causative factors of vascular aging. Deficient DDR, which may result in the accumulation of unrepaired damaged DNA or mutations, can lead to vascular aging. On the other hand, over-activation of some DDR proteins, such as poly (ADP ribose) polymerase (PARP) and ataxia telangiectasia mutated (ATM), also can enhance the process of vascular aging, suggesting that DDR can have both positive and negative effects on vascular aging. Despite the evidence reviewed in this paper, the role of DDR in vascular aging and potential therapeutic targets remain poorly understood and require further investigation.
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Affiliation(s)
- Xiao Zhang
- Sir William Dunn School of Pathology, University of Oxford, Oxford OX1 3RE, United Kingdom; Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; China International Neuroscience Institute (China-INI), Beijing 100053, China
| | - Qing Zhao
- M.D. Program, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; China International Neuroscience Institute (China-INI), Beijing 100053, China
| | - Qilin Long
- Sir William Dunn School of Pathology, University of Oxford, Oxford OX1 3RE, United Kingdom
| | - Yixin Sun
- First Hospital, Peking University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; China International Neuroscience Institute (China-INI), Beijing 100053, China; Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
| | - Monika Gullerova
- Sir William Dunn School of Pathology, University of Oxford, Oxford OX1 3RE, United Kingdom.
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Allen LA, Lowe EF, Matlock DD. The Economic Burden of Heart Failure with Reduced Ejection Fraction: Living Longer but Poorer? Cardiol Clin 2023; 41:501-510. [PMID: 37743073 DOI: 10.1016/j.ccl.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Treatment of heart failure with reduced ejection fraction (HFrEF) has benefitted from a proliferation of new medications and devices. These treatments carry important clinical benefits, but also come with costs relevant to payers, providers, and patients. Patient out-of-pocket costs have been implicated in the avoidance of medical care, nonadherence to medications, and the exacerbation of health care disparities. In the absence of major health care policy and payment redesign, high-quality HFrEF care delivery requires transparent integration of cost considerations into system design, patient-clinician interactions, and medical decision making.
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Affiliation(s)
- Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Academic Office One, #7019, Mailstop B130, Aurora, CO 80045, USA.
| | - Emily Fryman Lowe
- Department of Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Mailstop B177, Aurora, CO 80045, USA
| | - Dan D Matlock
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Children's Hospital Colorado, 1890 North Revere Court, Mailstop F44, Aurora, CO 80045, USA
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Masterson Creber R, Dodson JA, Bidwell J, Breathett K, Lyles C, Harmon Still C, Ooi SY, Yancy C, Kitsiou S. Telehealth and Health Equity in Older Adults With Heart Failure: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2023; 16:e000123. [PMID: 37909212 DOI: 10.1161/hcq.0000000000000123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Enhancing access to care using telehealth is a priority for improving outcomes among older adults with heart failure, increasing quality of care, and decreasing costs. Telehealth has the potential to increase access to care for patients who live in underresourced geographic regions, have physical disabilities or poor access to transportation, and may not otherwise have access to cardiologists with expertise in heart failure. During the COVID-19 pandemic, access to telehealth expanded, and yet barriers to access, including broadband inequality, low digital literacy, and structural barriers, prevented many of the disadvantaged patients from getting equitable access. Using a health equity lens, this scientific statement reviews the literature on telehealth for older adults with heart failure; provides an overview of structural, organizational, and personal barriers to telehealth; and presents novel interventions that pair telemedicine with in-person services to mitigate existing barriers and structural inequities.
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Thodi M, Bistola V, Lambrinou E, Keramida K, Nikolopoulos P, Parissis J, Farmakis D, Filippatos G. A randomized trial of a nurse-led educational intervention in patients with heart failure and their caregivers: impact on caregiver outcomes. Eur J Cardiovasc Nurs 2023; 22:709-718. [PMID: 36510826 DOI: 10.1093/eurjcn/zvac118] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/07/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
AIMS Psychoeducational interventions focusing on self-management of heart failure (HF) patients may improve patient health knowledge and reduce hospitalizations, but data regarding the effects on caregiver outcomes are inconclusive. METHODS AND RESULTS We conducted a single-centre, randomized controlled study to evaluate the effect of a nurse-led educational intervention in dyads of recently hospitalized HF patients and their caregivers on caregiver burden, feelings of guilt and health-related quality of life (HR-QoL). Dyads were randomized to usual care plus intervention group 1 (IG-1) or 2 (IG-2) or usual care only (control group, CG). Educational sessions in IG-1 and IG-2 were initiated before hospital discharge and continued with combination of home visits and telephone sessions in IG-1, or telephone sessions only in IG-2, delivered on regular intervals for 6 months. Caregiver burden was assessed by Heart Failure Caregiver Questionnaire (HF-CQ v5.0), guilt by Caregiver Guilt Questionnaire (CGQ), and QOL by EuroQol EQ-5D. Fifty-seven patient/caregiver dyads were included: 12 in IG-1, 18 in IG-2, and 27 in CG, of whom 11, 16, and 20, respectively, completed the study. All domains of HF-CQ and CGQ improved in IG-1 and IG-2 at 6 months, whereas deteriorated in CG (all P < 0.01). EQ-5D improved in IG-1 and IG-2 only in visual analogue scale part (P = 0.002), but not in the descriptive part. CONCLUSION A nurse-led, 6-month educational intervention on recently hospitalized HF patients/caregiver dyads, delivered through either combined home visits and telephone sessions or telephone sessions only, reduced caregiver burden and feelings of guilt, with lesser effect on HR-QoL. REGISTRATION ClinicalTrials.gov: NCT05480969.
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Affiliation(s)
- Maria Thodi
- Heart Failure Unit, 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, 12461 Athens, Greece
| | - Vasiliki Bistola
- Heart Failure Unit, 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, 12461 Athens, Greece
| | - Ekaterini Lambrinou
- Department of Nursing, Cyprus University of Technology, 15 Vragadinou Street, 3041 Limassol, Cyprus
| | - Kalliopi Keramida
- Heart Failure Unit, 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, 12461 Athens, Greece
- Cardiology Department, General Anti-Cancer Oncological Hospital Agios Savvas, 171 Alexandras Avenue, 11522 Athens, Greece
| | - Petros Nikolopoulos
- Heart Failure Unit, 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, 12461 Athens, Greece
| | - John Parissis
- Heart Failure Unit, 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, 12461 Athens, Greece
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, 12461 Athens, Greece
| | - Dimitrios Farmakis
- Heart Failure Unit, 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, 12461 Athens, Greece
- Department of Physiology, University of Cyprus Medical School, Palaios dromos Lefkosias Lemesou No.215/62029 Aglantzia, P.O.Box 20537, 1678 Nicosia, Cyprus
| | - Gerasimos Filippatos
- Heart Failure Unit, 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, 12461 Athens, Greece
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Lönn A, Börjesson M, Hambraeus K, Ekblom Ö. Changes in Physical Activity and Incidence of Nonfatal Cardiovascular Events in 47 153 Survivors of Myocardial Infarction. J Am Heart Assoc 2023; 12:e030583. [PMID: 37804194 PMCID: PMC10757539 DOI: 10.1161/jaha.123.030583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/14/2023] [Indexed: 10/09/2023]
Abstract
Background The majority of patients survive the acute phase of myocardial infarction (MI) but have an increased risk of recurrent cardiovascular disease (CVD) events. To be regularly physically active or change activity level is associated with a lower risk of all-cause mortality. The objective was to explore to what extent physical activity (PA) levels or change in PA levels during the first year post-MI was associated with any recurrent nonfatal CVD events and specific CVD events (eg, MI, ischemic stroke, and vascular dementia). Methods and Results This cohort study among MI survivors was based on Swedish national registries between 2005 and 2020. PA levels were self-rated at 2 and 12 months post-MI, and patients were classified into remaining physically inactive, increasing, decreasing, or remaining active. A total of 6534 nonfatal CVD events occurred during 6 years of follow-up among the 47 153 included patients. In fully adjusted analyses, the risk of any nonfatal CVD event was lower (P<0.05) among patients remaining active (37%), increasing (22%), or decreasing (18%) PA level compared with remaining inactive. Compared with remaining inactive, the risk of recurring MI and stroke was lower (P>0.05) among remaining active (41% versus 52%, respectively), increasing (20% versus 35%, respectively), or decreasing PA level (24% versus 34%, respectively). For vascular dementia, patients remaining physically active had an 80% lower risk compared with remaining inactive (P<0.05). Conclusions Remaining physically active or change in PA levels during the first year post-MI was associated with a lower risk of recurrent nonfatal CVD events. This emphasizes the importance of supporting patients to continue to be or become physically active.
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Affiliation(s)
- Amanda Lönn
- Department of Physical Activity and HealthThe Swedish School of Sport and Health SciencesStockholmSweden
- Women’s Health and Allied Health Professionals Theme Medical Unit Occupational Therapy and PhysiotherapyKarolinska University HospitalStockholmSweden
| | - Mats Börjesson
- Center for Lifestyle Intervention, Department of MGAÖSahlgrenska University Hospital, Region of Västra GötalandGothenburgSweden
- Department of Molecular and Clinical Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | | | - Örjan Ekblom
- Department of Physical Activity and HealthThe Swedish School of Sport and Health SciencesStockholmSweden
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Ramamoorthy V, Chan K, Roy M, Saxena A, Ahmed MA, Zhang Z, Appunni S, Thomas R, McGranaghan P, McDermott M, La Rosa FDLR, Rubens M. Healthcare expenditure trends among adult stroke patients in the United States, 2011-2020. J Stroke Cerebrovasc Dis 2023; 32:107333. [PMID: 37659191 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/12/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND In the US, between 2018 and 2019, approximately $57 billion were expended on stroke and related conditions. The aim of this study was to understand trends in direct healthcare expenditures among stroke patients using novel cost estimation methods and a nationally representative database. METHODS This study was a retrospective analysis of 193,003 adults, ≥18 years of age, using the Medical Expenditure Panel Survey during 2009-2016. Manning and Mullahy's two-part model were used to calculate adjusted mean and incremental medical expenditures after adjusting for covariates. RESULTS The mean (Standard Deviation) direct annual healthcare expenditure among stroke patients was $16,979.0 ($16,222.0- $17,736.0) and was nearly 3 times greater than non-stroke participants which were $5,039.7 ($4,951.0-$5,128.5) and were mainly spent on inpatient services, prescription medications, and office-based visits. Stroke patients had an additional healthcare expenditure of $4096.0 (3543.9, 4648.1) per person per year, compared to participants without stroke after adjusting for covariates (P<0.001). The total mean annual direct healthcare expenditure for stroke survivors increased from $16,142.0 (15,017.0-17,267.0) in 2007-2008 to $16,979.0 (16,222.0-17,736.0) in 2015-2016. CONCLUSION Our study showed that stroke survivors had significantly greater healthcare expenses, compared to non-stroke individuals, mainly due to higher expenditures on inpatient services, prescription drugs, and office visits. These findings are concerning because the prevalence of stroke is projected to increase due to aging population and increased survival rates.
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Affiliation(s)
| | - Kelvin Chan
- Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Mukesh Roy
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Anshul Saxena
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Md Ashfaq Ahmed
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL 33176, USA
| | - Zhenwei Zhang
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL 33176, USA
| | | | | | - Peter McGranaghan
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Michael McDermott
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; Baptist Health South Florida, Miami Neuroscience Institute, Miami, Florida 33176, USA
| | - Felipe De Los Rios La Rosa
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; Baptist Health South Florida, Miami Neuroscience Institute, Miami, Florida 33176, USA
| | - Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; Universidad Espíritu Santo, Ecuador.
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Nkemdirim Okere A, Moussa RK, Ali A, Diaby VK. Development and validation of a tool to predict high-need, high-cost patients hospitalised with ischaemic heart disease. BMJ Open 2023; 13:e073485. [PMID: 37751949 PMCID: PMC10533782 DOI: 10.1136/bmjopen-2023-073485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE To develop and validate a tool to predict patients with ischaemic heart disease (IHD) at risk of excessive healthcare resource utilisation. DESIGN A retrospective cohort study. SETTING We identified patients through the State of Florida Agency for Health Care Administration (N=586 518) inpatient dataset. PARTICIPANTS Adult patients (at least 40 years of age) admitted to the hospital with a diagnosis of IHD between 1 January 2007 and 31 December 2016. PRIMARY OUTCOME MEASURES We identified patients whose healthcare utilisation is higher than presumed (analysis of residuals) and used logistic regression (binary and multinomial) in estimating the predictive models to classify individual as high-need, high-care (HNHC) patients relative to inpatient visits (frequency of hospitalisation), cost and hospital length of stay. Discrimination power, prediction accuracy and model improvement for the binary logistic model were assessed using receiver operating characteristic statistic, the Brier score and the log-likelihood (LL)-based pseudo-R2, respectively. LL-based pseudo-R2 and Brier score were used for multinomial logistic models. RESULTS The binary logistic model had good discrimination power (c-statistic=0.6496), an accuracy of probabilistic predictions (Brier score) of 0.0621 and an LL-based pseudo-R2 of 0.0338 in the development cohort. The model performed similarly in the validation cohort (c-statistic=0.6480), an accuracy of probabilistic predictions (Brier score) of 0.0620 and an LL-based pseudo-R2 of 0.0380. A user-friendly Excel-based HNHC risk predictive tool was developed and readily available for clinicians and policy decision-makers. CONCLUSIONS The Excel-based HNHC risk predictive tool can accurately identify at-risk patients for HNHC based on three measures of healthcare expenditures.
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Affiliation(s)
- Arinze Nkemdirim Okere
- Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, Tallahassee, Florida, USA
| | - Richard K Moussa
- Ecole Nationale Supérieure de Statistique et d'Économie Appliquée, Abidjan, Côte d'Ivoire
| | - Askal Ali
- Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, Tallahassee, Florida, USA
| | - Vakaramoko K Diaby
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
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Gossa Al-Saadde DL, Haider AM, Ali A, Abdu Musad Saleh E, Turki Jalil A, Abdulelah FM, Romero-Parra RM, Tayyib NA, Ramírez-Coronel AA, Alkhayyat AS. The role of chromium supplementation in cardiovascular risk factors: A comprehensive reviews of putative molecular mechanisms. Heliyon 2023; 9:e19826. [PMID: 37809394 PMCID: PMC10559203 DOI: 10.1016/j.heliyon.2023.e19826] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 08/25/2023] [Accepted: 09/01/2023] [Indexed: 10/10/2023] Open
Abstract
In the recent years, micronutrients play an important role in improving body health with preventing and treating of chronic diseases. Chromium is one of the vital minerals involved in the regulation of insulin action. According to abundant evidences this mineral seems to be an essential factor involved in the reduction of insulin resistance and decreasing the risk of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVDs). Moreover, it has been proposed that Chromium supplementation affects mechanisms involved in blood pressure, lipid metabolism, inflammation, and oxidative stress. For instance, it may affect blood pressure through alteration of the renin-angiotensin system, as well as reducing the angiotensin-converting enzyme activity. Furthermore, Chromium supplementation might help reduce the coronary heart disease rates. This study aims to provide a comprehensive review regarding to the effects of Chromium supplementation on CVDs risk factors with an emphasis on possible molecular mechanisms.
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Affiliation(s)
| | | | - Arsalan Ali
- Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Ebraheem Abdu Musad Saleh
- Department of Chemistry, Prince Sattam Bin Abdulaziz University, College of Arts and Science, Wadi Al-Dawasir, 11991, Saudi Arabia
| | - Abduladheem Turki Jalil
- Medical Laboratories Techniques Department, Al-Mustaqbal University College, Babylon, Hilla, 51001, Iraq
| | | | | | - Nahla A. Tayyib
- Faculty of Nursing, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Andrés Alexis Ramírez-Coronel
- Catholic University of Cuenca, Azogues Campus, Ecuador
- University of Palermo, Buenos Aires, Argentina
- National University of Education, Azogues, Ecuador
- CES University, Colombia
| | - Ameer S. Alkhayyat
- Medical Laboratory Technology Department, College of Medical Technology, The Islamic University, Najaf, Iraq
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Mohsen F, Al-Saadi B, Abdi N, Khan S, Shah Z. Artificial Intelligence-Based Methods for Precision Cardiovascular Medicine. J Pers Med 2023; 13:1268. [PMID: 37623518 PMCID: PMC10455092 DOI: 10.3390/jpm13081268] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/27/2023] [Accepted: 03/04/2023] [Indexed: 08/26/2023] Open
Abstract
Precision medicine has the potential to revolutionize the way cardiovascular diseases are diagnosed, predicted, and treated by tailoring treatment strategies to the individual characteristics of each patient. Artificial intelligence (AI) has recently emerged as a promising tool for improving the accuracy and efficiency of precision cardiovascular medicine. In this scoping review, we aimed to identify and summarize the current state of the literature on the use of AI in precision cardiovascular medicine. A comprehensive search of electronic databases, including Scopes, Google Scholar, and PubMed, was conducted to identify relevant studies. After applying inclusion and exclusion criteria, a total of 28 studies were included in the review. We found that AI is being increasingly applied in various areas of cardiovascular medicine, including the diagnosis, prognosis of cardiovascular diseases, risk prediction and stratification, and treatment planning. As a result, most of these studies focused on prediction (50%), followed by diagnosis (21%), phenotyping (14%), and risk stratification (14%). A variety of machine learning models were utilized in these studies, with logistic regression being the most used (36%), followed by random forest (32%), support vector machine (25%), and deep learning models such as neural networks (18%). Other models, such as hierarchical clustering (11%), Cox regression (11%), and natural language processing (4%), were also utilized. The data sources used in these studies included electronic health records (79%), imaging data (43%), and omics data (4%). We found that AI is being increasingly applied in various areas of cardiovascular medicine, including the diagnosis, prognosis of cardiovascular diseases, risk prediction and stratification, and treatment planning. The results of the review showed that AI has the potential to improve the performance of cardiovascular disease diagnosis and prognosis, as well as to identify individuals at high risk of developing cardiovascular diseases. However, further research is needed to fully evaluate the clinical utility and effectiveness of AI-based approaches in precision cardiovascular medicine. Overall, our review provided a comprehensive overview of the current state of knowledge in the field of AI-based methods for precision cardiovascular medicine and offered new insights for researchers interested in this research area.
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Affiliation(s)
| | | | | | | | - Zubair Shah
- College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha 34110, Qatar
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Rossi LP, Granger BB, Bruckel JT, Crabbe DL, Graven LJ, Newlin KS, Streur MM, Vadiveloo MK, Walton-Moss BJ, Warden BA, Volgman AS, Lydston M. Person-Centered Models for Cardiovascular Care: A Review of the Evidence: A Scientific Statement From the American Heart Association. Circulation 2023; 148:512-542. [PMID: 37427418 DOI: 10.1161/cir.0000000000001141] [Citation(s) in RCA: 1] [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] [Indexed: 07/11/2023]
Abstract
Cardiovascular disease remains the leading cause of death and disability in the United States and globally. Disease burden continues to escalate despite technological advances associated with improved life expectancy and quality of life. As a result, longer life is associated with multiple chronic cardiovascular conditions. Clinical guidelines provide recommendations without considering prevalent scenarios of multimorbidity and health system complexities that affect practical adoption. The diversity of personal preferences, cultures, and lifestyles that make up one's social and environmental context is often overlooked in ongoing care planning for symptom management and health behavior support, hindering adoption and compromising patient outcomes, particularly in groups at high risk. The purpose of this scientific statement was to describe the characteristics and reported outcomes in existing person-centered care delivery models for selected cardiovascular conditions. We conducted a scoping review using Ovid MEDLINE, Embase.com, Web of Science, CINAHL Complete, Cochrane Central Register of Controlled Trials through Ovid, and ClinicalTrials.gov from 2010 to 2022. A range of study designs with a defined aim to systematically evaluate care delivery models for selected cardiovascular conditions were included. Models were selected on the basis of their stated use of evidence-based guidelines, clinical decision support tools, systematic evaluation processes, and inclusion of the patient's perspective in defining the plan of care. Findings reflected variation in methodological approach, outcome measures, and care processes used across models. Evidence to support optimal care delivery models remains limited by inconsistencies in approach, variation in reimbursement, and inability of health systems to meet the needs of patients with chronic, complex cardiovascular conditions.
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Michaeli DT, Michaeli JC, Boch T, Michaeli T. Cost-Effectiveness of Lipid-Lowering Therapies for Cardiovascular Prevention in Germany. Cardiovasc Drugs Ther 2023; 37:683-694. [PMID: 35015186 PMCID: PMC10397126 DOI: 10.1007/s10557-021-07310-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Novel pharmaceutical treatments reducing cardiovascular events in dyslipidaemia patients must demonstrate clinical efficacy and cost-effectiveness to promote long-term adoption by patients, physicians, and insurers. OBJECTIVE To assess the cost-effectiveness of statin monotherapy compared to additive lipid-lowering therapies for primary and secondary cardiovascular prevention from the perspective of Germany's healthcare system. METHODS Transition probabilities and hazard ratios were derived from cardiovascular outcome trials for statin combinations with icosapent ethyl (REDUCE-IT), evolocumab (FOURIER), alirocumab (ODYSSEY), ezetimibe (IMPROVE-IT), and fibrate (ACCORD). Costs and utilities were retrieved from previous literature. The incidence of major adverse cardiovascular events was simulated with a Markov cohort model. The main outcomes were the incremental cost-effectiveness ratios (ICER) per quality adjusted life year (QALY) gained. RESULTS For primary prevention, the addition of icosapent ethyl to statin generated 0.81 QALY and €14,732 costs (ICER: 18,133), whereas fibrates yielded 0.63 QALY and € - 10,516 costs (ICER: - 16,632). For secondary prevention, the addition of ezetimibe to statin provided 0.61 QALY at savings of € - 5,796 (ICER: - 9,555) and icosapent ethyl yielded 0.99 QALY and €14,333 costs (ICER: 14,485). PCSK9 inhibitors offered 0.55 and 0.87 QALY at costs of €62,722 and €87,002 for evolocumab (ICER: 114,639) and alirocumab (ICER: 100,532), respectively. A 95% probability of cost-effectiveness was surpassed at €20,000 for icosapent ethyl (primary and secondary prevention), €119,000 for alirocumab, and €149,000 for evolocumab. CONCLUSIONS For primary cardiovascular prevention, a combination therapy of icosapent ethyl plus statin is a cost-effective use of resources compared to statin monotherapy. For secondary prevention, icosapent ethyl, ezetimibe, evolocumab, and alirocumab increase patient benefit at different economic costs.
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Affiliation(s)
- Daniel Tobias Michaeli
- Fifth Department of Medicine, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.
- Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.
| | - Julia Caroline Michaeli
- Fifth Department of Medicine, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
- Department of Obstetrics and Gynecology, Asklepios-Clinic Hamburg Altona, Asklepios Hospital Group, Hamburg, Germany
| | - Tobias Boch
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
- Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Thomas Michaeli
- Fifth Department of Medicine, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
- Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
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Kumar G, Fang S, Golosova D, Lu KT, Brozoski DT, Vazirabad I, Sigmund CD. Structure and Function of RhoBTB1 Required for Substrate Specificity and Cullin-3 Ubiquitination. FUNCTION 2023; 4:zqad034. [PMID: 37575477 PMCID: PMC10413933 DOI: 10.1093/function/zqad034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 08/15/2023] Open
Abstract
We identified Rho-related BTB domain containing 1 (RhoBTB1) as a key regulator of phosphodiesterase 5 (PDE5) activity, and through PDE5, a regulator of vascular tone. We identified the binding interface for PDE5 on RhoBTB1 by truncating full-length RhoBTB1 into its component domains. Co-immunoprecipitation analyses revealed that the C-terminal half of RhoBTB1 containing its two BTB domains and the C-terminal domain (B1B2C) is the minimal region required for PDE5 recruitment and subsequent proteasomal degradation via Cullin-3 (CUL3). The C-terminal domain was essential in recruiting PDE5 as constructs lacking this region could not participate in PDE5 binding or proteasomal degradation. We also identified Pro353 and Ser363 as key amino acid residues in the B1B2C region involved in CUL3 binding to RhoBTB1. Mutation of either of these residues exhibited impaired CUL3 binding and PDE5 degradation, although the binding to PDE5 was preserved. Finally, we employed ascorbate peroxidase 2 (APEX2) proximity labeling using a B1B2C-APEX2 fusion protein as bait to capture unknown RhoBTB1 binding partners. Among several B1B2C-binding proteins identified and validated, we focused on SET domain containing 2 (SETD2). SETD2 and RhoBTB1 directly interacted, and the level of SETD2 increased in response to pharmacological inhibition of the proteasome or Cullin complex, CUL3 deletion, and RhoBTB1-inhibition with siRNA. This suggests that SETD2 is regulated by the RhoBTB1-CUL3 axis. Future studies will determine whether SETD2 plays a role in cardiovascular function.
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Affiliation(s)
- Gaurav Kumar
- Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Shi Fang
- Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Daria Golosova
- Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Ko-Ting Lu
- Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Daniel T Brozoski
- Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Ibrahim Vazirabad
- Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Curt D Sigmund
- Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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44
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Garber L, Khodaei S, Maftoon N, Keshavarz-Motamed Z. Impact of TAVR on coronary artery hemodynamics using clinical measurements and image-based patient-specific in silico modeling. Sci Rep 2023; 13:8948. [PMID: 37268642 DOI: 10.1038/s41598-023-31987-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/21/2023] [Indexed: 06/04/2023] Open
Abstract
In recent years, transcatheter aortic valve replacement (TAVR) has become the leading method for treating aortic stenosis. While the procedure has improved dramatically in the past decade, there are still uncertainties about the impact of TAVR on coronary blood flow. Recent research has indicated that negative coronary events after TAVR may be partially driven by impaired coronary blood flow dynamics. Furthermore, the current technologies to rapidly obtain non-invasive coronary blood flow data are relatively limited. Herein, we present a lumped parameter computational model to simulate coronary blood flow in the main arteries as well as a series of cardiovascular hemodynamic metrics. The model was designed to only use a few inputs parameters from echocardiography, computed tomography and a sphygmomanometer. The novel computational model was then validated and applied to 19 patients undergoing TAVR to examine the impact of the procedure on coronary blood flow in the left anterior descending (LAD) artery, left circumflex (LCX) artery and right coronary artery (RCA) and various global hemodynamics metrics. Based on our findings, the changes in coronary blood flow after TAVR varied and were subject specific (37% had increased flow in all three coronary arteries, 32% had decreased flow in all coronary arteries, and 31% had both increased and decreased flow in different coronary arteries). Additionally, valvular pressure gradient, left ventricle (LV) workload and maximum LV pressure decreased by 61.5%, 4.5% and 13.0% respectively, while mean arterial pressure and cardiac output increased by 6.9% and 9.9% after TAVR. By applying this proof-of-concept computational model, a series of hemodynamic metrics were generated non-invasively which can help to better understand the individual relationships between TAVR and mean and peak coronary flow rates. In the future, tools such as these may play a vital role by providing clinicians with rapid insight into various cardiac and coronary metrics, rendering the planning for TAVR and other cardiovascular procedures more personalized.
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Affiliation(s)
- Louis Garber
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Seyedvahid Khodaei
- Department of Mechanical Engineering (Mail to JHE-310), McMaster University, Hamilton, ON, L8S 4L7, Canada
| | - Nima Maftoon
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
- Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, ON, Canada
| | - Zahra Keshavarz-Motamed
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
- Department of Mechanical Engineering (Mail to JHE-310), McMaster University, Hamilton, ON, L8S 4L7, Canada.
- School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada.
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Wang J, Wang YQ, Shi J, Yu PM, Guo YQ. Effect of preoperative inspiratory muscle training on postoperative outcomes in patients undergoing cardiac surgery: A systematic review and meta-analysis. World J Clin Cases 2023; 11:2981-2991. [PMID: 37215418 PMCID: PMC10198094 DOI: 10.12998/wjcc.v11.i13.2981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/10/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Cardiovascular disease is the most prevalent disease worldwide and places a great burden on the health and economic welfare of patients. Cardiac surgery is an important way to treat cardiovascular disease, but it can prolong mechanical ventilation time, intensive care unit (ICU) stay, and postoperative hospitalization for patients. Previous studies have demonstrated that preoperative inspiratory muscle training could decrease the incidence of postoperative pulmonary complications.
AIM To explore the effect of preoperative inspiratory muscle training on mechanical ventilation time, length of ICU stay, and duration of postoperative hospitalization after cardiac surgery.
METHODS A literature search of PubMed, Web of Science, Cochrane Library, EMBASE, China National Knowledge Infrastructure, WanFang, and the China Science and Technology journal VIP database was performed on April 13, 2022. The data was independently extracted by two authors. The inclusion criteria were: (1) Randomized controlled trial; (2) Accessible as a full paper; (3) Patients who received cardiac surgery; (4) Preoperative inspiratory muscle training was implemented in these patients; (5) The study reported at least one of the following: Mechanical ventilation time, length of ICU stay, and/or duration of postoperative hospitalization; and (6) In English language.
RESULTS We analyzed six randomized controlled trials with a total of 925 participants. The pooled mean difference of mechanical ventilation time was -0.45 h [95% confidence interval (CI): -1.59-0.69], which was not statistically significant between the intervention group and the control group. The pooled mean difference of length of ICU stay was 0.44 h (95%CI: -0.58-1.45). The pooled mean difference of postoperative hospitalization was -1.77 d in the intervention group vs the control group [95%CI: -2.41-(-1.12)].
CONCLUSION Preoperative inspiratory muscle training may decrease the duration of postoperative hospitalization for patients undergoing cardiac surgery. More high-quality studies are needed to confirm our conclusion.
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Affiliation(s)
- Jing Wang
- Department of Cardiovascular Surgery, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Yu-Qiang Wang
- Department of Cardiovascular Surgery, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Jun Shi
- Department of Cardiovascular Surgery, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Peng-Ming Yu
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ying-Qiang Guo
- Department of Cardiovascular Surgery, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
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Valleggi A, Passino C, Emdin M, Murante AM. Differences in family caregiver experiences and expectations of end-of-life heart failure care across providers and settings: a systematic literature review. BMC Health Serv Res 2023; 23:429. [PMID: 37138363 PMCID: PMC10155156 DOI: 10.1186/s12913-023-09241-w] [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: 10/25/2021] [Accepted: 03/03/2023] [Indexed: 05/05/2023] Open
Abstract
Heart failure impacts patients' quality of life and life expectancy and significantly affects the daily behaviours and feelings of family caregivers. At the end-of-life, the burden for family caregivers depends on their emotional and sentimental involvement, as well as social costs. OBJECTIVES The aim of this work is to determine whether and how family caregivers' experiences and expectations vary in relation to the places of care and teams involved in heart failure management. METHODS A systematic literature review was conducted, by screening manuscripts dealing with the experience of Family Care Givers' (FCGs) of patients with Advanced Heart failure. Methods and results were reported following the PRISMA rules. Papers were searched through three databases (PubMed, Scopus and Web of Science). Seven topics were used to synthetize results by reporting qualitative information and quantitative evidence about the experience of FCGs in places of care and with care teams. RESULTS Thirty-one papers, dealing with the experience of 814 FCGs, were selected for this systematic review. Most manuscripts came from the USA (N = 14) and European countries (N = 13) and were based on qualitative methods. The most common care setting and provider profile combination at the end of life was home care (N = 22) and multiprofessional teams (N = 27). Family caregivers experienced "psychological issues" (48.4%), impact of patients' condition on their life (38,7%) and "worries for the future" (22.6%). Usually, when family caregivers were unprepared for the future, the care setting was the home, and there was a lack of palliative physicians on the team. DISCUSSION At the end-of-life, the major needs of chronic patients and their relatives are not health related. And, as we observed, non-health needs can be satisfied by improving some key components of the care management process that could be related to care team and setting of care. Our findings can support the design of new policies and strategies.
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Affiliation(s)
| | - Claudio Passino
- Fondazione Gabriele Monasterio, Pisa, Italy
- Interdisciplinary Research Center Health Science, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Michele Emdin
- Fondazione Gabriele Monasterio, Pisa, Italy
- Interdisciplinary Research Center Health Science, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Anna Maria Murante
- Management and Health Lab - Institute of Management, Scuola Superiore San'Anna, Pisa, Italy.
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Cross LA, Koren A, Dowling JS, Gonzales JE. Compassion Fatigue and Family Caregivers Caring in End-Stage Heart Failure. Res Theory Nurs Pract 2023; 37:195-213. [PMID: 37263637 DOI: 10.1891/rtnp-2022-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Background: Compassion fatigue is a negative consequence impacting caregivers of chronic illness, such as heart failure. Reliance on family caregivers is expected to rise, placing importance on recognizing family caregiver characteristics that contribute to compassion fatigue. Purpose: This study specifically examined the associations of characteristics of family caregivers caring for end-stage heart failure, compassion satisfaction, social desirability, and the family caregiver-nursing provider relationship on compassion fatigue. Methods: An adapted interaction model of client health behavior guided this cross-sectional survey, which comprised a demographic questionnaire, the Professional Quality-of-Life Scale, the caregiver-provider relationship assessment, the Marlowe-Crowne Social Desirability Scale Short Form (Form C), and the Bakas Caregiving Outcomes Scale. Results: There were 127 family caregivers (FCGs), primarily those who have been a caregiver for longer than 1 year (78.4%), who completed the entire survey. Increased compassion satisfaction and positive caregiving effects were associated with decreased compassion fatigue (p < .001), while increased social desirability was associated with increased compassion fatigue (p < .001). A positive family caregiver-nursing provider relationship was related to decreased compassion fatigue (p < .001). More compassion fatigue was seen with lower spiritual status (p < .001). Implications: The chronic progression of heart failure presents opportunities for nursing providers to assess caregivers and offer frequent interventions. Family caregivers may not ask for help. Nursing providers must foster relationships with family caregivers to prevent negative consequences and mitigate compassion fatigue. Future research on the nursing provider relationship and FCGs is needed.
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Affiliation(s)
- Lisa A Cross
- School of Nursing, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA
| | - Ainat Koren
- Solomont School of Nursing, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Jacqueline S Dowling
- Solomont School of Nursing, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Joseph E Gonzales
- Department of Psychology, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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Jacobs M, Ellis C. Healthcare cost and race: analysis of young women with stroke. Int J Equity Health 2023; 22:69. [PMID: 37085848 PMCID: PMC10122319 DOI: 10.1186/s12939-023-01886-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/05/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Over the last decade, the prevalence of young stroke has increased 40% particularly among vulnerable populations. These strokes are often more severe with worse outcomes. However, few studies have examined the impact on annual healthcare costs. METHODS Data from the 2008 to 2018 Medical Expenditure Panel Survey (MEPS) was used to identify a sample of female stroke survivors aged 18 and 60. MEPS includes demographics, health status, healthcare use, and expenditures for all participants providing the largest nationally representative data source of healthcare costs in the US. First, differences in racial and ethnic healthcare expenditure among young women with stroke were evaluated controlling for insurance type and demographic characteristics. Second, the relationship between healthcare expenditure and 1) time post stroke, 2) comorbidities, 3) healthcare utilization, and 4) post-stroke functional status was assessed. Finally, differential healthcare quality was tested as a potential mitigating differential. RESULTS Young Black women with stroke spend roughly 20% more on healthcare than White women after controlling for insurance, time post-stroke, healthcare utilization, and demographic differences. Costs remain 17% higher after controlling for comorbidities. Differences in expenditure are larger if survivors have diabetes, high blood pressure, or high cholesterol (78%, 24%, and 28%, respectively). Higher expenditure could not be explained by higher healthcare utilization, but lower quality of healthcare may explain part of the differential. CONCLUSION Young Black women with stroke have 20% greater healthcare expenditure than other groups. Cost differentials cannot be explained by differentials in comorbidities, utilization, time post stroke, or functionality. Additional research is needed to explain these differences.
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Affiliation(s)
- Molly Jacobs
- Department of Health Services Research, Management and Policy, University of Florida, 1225 Center Drive, Gainesville, FL, 32603, USA.
| | - Charles Ellis
- Department of Speech, Language, and Hearing Sciences, University of Florida, 1225 Center Drive, Gainesville, FL, 32603, USA
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Wechsler PM, Liberman AL, Restifo D, Abramson EL, Navi BB, Kamel H, Parikh NS. Cost-Effectiveness of Smoking Cessation Interventions in Patients With Ischemic Stroke and Transient Ischemic Attack. Stroke 2023; 54:992-1000. [PMID: 36866670 PMCID: PMC10050136 DOI: 10.1161/strokeaha.122.040356] [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: 06/16/2022] [Accepted: 02/17/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Smoking cessation rates after stroke and transient ischemic attack are suboptimal, and smoking cessation interventions are underutilized. We performed a cost-effectiveness analysis of smoking cessation interventions in this population. METHODS We constructed a decision tree and used Markov models that aimed to assess the cost-effectiveness of varenicline, any pharmacotherapy with intensive counseling, and monetary incentives, compared with brief counseling alone in the secondary stroke prevention setting. Payer and societal costs of interventions and outcomes were modeled. The outcomes were recurrent stroke, myocardial infarction, and death using a lifetime horizon. Estimates and variance for the base case (35% cessation), costs and effectiveness of interventions, and outcome rates were imputed from the stroke literature. We calculated incremental cost-effectiveness ratios and incremental net monetary benefits. An intervention was considered cost-effective if the incremental cost-effectiveness ratio was less than the willingness-to-pay threshold of $100 000 per quality-adjusted life-year (QALY) or when the incremental net monetary benefit was positive. Probabilistic Monte Carlo simulations modeled the impact of parameter uncertainty. RESULTS From the payer perspective, varenicline and pharmacotherapy with intensive counseling were associated with more QALYs (0.67 and 1.00, respectively) at less total lifetime costs compared with brief counseling alone. Monetary incentives were associated with 0.71 more QALYs at an additional cost of $120 compared with brief counseling alone, yielding an incremental cost-effectiveness ratio of $168/QALY. From the societal perspective, all 3 interventions provided more QALYs at less total costs compared with brief counseling alone. In 10 000 Monte Carlo simulations, all 3 smoking cessation interventions were cost-effective in >89% of runs. CONCLUSIONS For secondary stroke prevention, it is cost-effective and potentially cost-saving to deliver smoking cessation therapy beyond brief counseling alone.
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Affiliation(s)
- Paul M Wechsler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Ava L Liberman
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Daniel Restifo
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Erika L Abramson
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
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50
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Tang L, Yang J, Wang Y, Deng R. Recent Advances in Cardiovascular Disease Biosensors and Monitoring Technologies. ACS Sens 2023; 8:956-973. [PMID: 36892106 DOI: 10.1021/acssensors.2c02311] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Cardiovascular disease (CVD) causes significant mortality and remains the leading cause of death globally. Thus, to reduce mortality, early diagnosis by measurement of cardiac biomarkers and heartbeat signals presents fundamental importance. Traditional CVD examination requires bulky hospital instruments to conduct electrocardiography recording and immunoassay analysis, which are both time-consuming and inconvenient. Recently, development of biosensing technologies for rapid CVD marker screening attracted great attention. Thanks to the advancement in nanotechnology and bioelectronics, novel biosensor platforms are developed to achieve rapid detection, accurate quantification, and continuous monitoring throughout disease progression. A variety of sensing methodologies using chemical, electrochemical, optical, and electromechanical means are explored. This review first discusses the prevalence and common categories of CVD. Then, heartbeat signals and cardiac blood-based biomarkers that are widely employed in clinic, as well as their utilizations for disease prognosis, are summarized. Emerging CVD wearable and implantable biosensors and monitoring bioelectronics, allowing these cardiac markers to be continuously measured are introduced. Finally, comparisons of the pros and cons of these biosensing devices along with perspectives on future CVD biosensor research are presented.
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Affiliation(s)
- Lichao Tang
- Targeted Tracer Research and Development Laboratory, Institute of Respiratory Health, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, 60208, Illinois, United States
| | - Jiyuan Yang
- Targeted Tracer Research and Development Laboratory, Institute of Respiratory Health, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, 47906, Indiana, United States
| | - Yuxi Wang
- Targeted Tracer Research and Development Laboratory, Institute of Respiratory Health, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Precision Medicine Key Laboratory of Sichuan Province & Precision Medicine Research Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ruijie Deng
- College of Biomass Science and Engineering, Healthy Food Evaluation Research Center, Sichuan University, Chengdu, 610064, Sichuan, China
- Precision Medicine Key Laboratory of Sichuan Province & Precision Medicine Research Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
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