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Chaturvedi A, Garcia-Garcia HM, Cellamare M, Zhang C, Chandrika P, Abusnina W, Chitturi KR, Haberman D, Lupu L, Merdler I, Case BC, Hashim HD, Ben-Dor I, Waksman R. Racial Disparities in Outcomes of Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction Secondary to Spontaneous Coronary Artery Dissection. Am J Cardiol 2024; 225:52-60. [PMID: 38906395 DOI: 10.1016/j.amjcard.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/01/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024]
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of ST-segment elevation myocardial infarction (STEMI), predominantly affecting women. Because primary percutaneous coronary intervention (PPCI) is reserved for a select group of patients, vulnerable and minority patients may experience delays in appropriate management and adverse outcomes. We examined the racial differences in the outcomes for patients with SCAD who underwent PPCI for STEMI. Records of patients aged ≥18 years who underwent PPCI for SCAD-related STEMI between 2016 and 2020 were identified from the National Inpatient Sample database. Clinical, socioeconomic, and hospital characteristics were compared between non-White and White patients. Weighted multivariate analysis assessed the association of race with inpatient mortality, length of stay (LOS), and hospitalization costs. The total weighted estimate of patients with SCAD-STEMI who underwent PPCI was 4,945, constituting 25% non-White patients. Non-White patients were younger (56 vs 60.7 years, p <0.001); had a higher prevalence of diabetes, acute renal failure, and obesity; and were more likely to be uninsured and be in the lowest income group. Inpatient mortality (7.7% vs 8.4%, p = 0.74) and hospitalization costs ($34,213 vs $31,858, p = 0.27) were similar for non-White and White patients, and the adjusted analysis did not show any association between the patients' race and inpatient mortality (odds ratio 0.60, 95% confidence interval [CI] 0.32 to 1.13, p = 0.11) or hospitalization costs (β [β coefficient]: 215, 95% CI -4,193 to 4,623, p >0.90). Similarly, there was no association between the patients' race and LOS (incident rate ratio 1.20, 95% CI 1.00 to 1.45, p = 0.054). The weighted multivariate analysis showed that age; clinical co-morbidities such as diabetes, acute renal failure, valvular dysfunction, and obesity; low-income status; and hospitalization in the western region were associated with adverse outcomes. In conclusion, our study does not show any differences in inpatient mortality, LOS, and hospitalization costs between non-White and White patients who underwent PPCI for SCAD-related STEMI.
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Affiliation(s)
- Abhishek Chaturvedi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia.
| | - Matteo Cellamare
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Cheng Zhang
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Parul Chandrika
- Internal Medicine, MedStar Shah Medical Group, White Plains, Maryland
| | - Waiel Abusnina
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Kalyan R Chitturi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Dan Haberman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Lior Lupu
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Ilan Merdler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Hayder D Hashim
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington District of Columbia.
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Coviello A, Cirillo D, Vargas M, de Siena AU, Barone MS, Esposito F, Izzo A, Buonanno P, Volpe S, Stingone AG, Iacovazzo C. Preoperative Echocardiographic Unknown Valvopathy Evaluation in Elderly Patients Undergoing Neuraxial Anesthesia during Major Orthopedic Surgery: A Mono-Centric Retrospective Study. J Clin Med 2024; 13:3511. [PMID: 38930041 PMCID: PMC11204530 DOI: 10.3390/jcm13123511] [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: 04/20/2024] [Revised: 05/31/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The assessment of cardiac risk is challenging for elderly patients undergoing major orthopedic surgery with preoperative functional limitations. Currently, no specific cardiac risk scores are available for these critical patients. Echocardiography may be a reliable and safe instrument for assessing cardiac risks in this population. This study aims to evaluate the potential benefits of echocardiography in elderly orthopedic patients, its impact on anesthesiologic management, and postoperative Major Adverse Cardiac Events (MACEs). Methods: This is a retrospective, one-arm, monocentric study conducted at ''Federico II'' Hospital-University of Naples-from January to December 2023, where 59 patients undergoing hip or knee revision surgery under neuraxial anesthesia were selected. The demographic data, the clinical history, and the results of preoperative Echocardiography screening (pEco-s) were collected. After extensive descriptive statistics, the χ2 test was used to compare the valvopathies and impaired Left Ventricular Function (iLVEF) prevalence before and after echocardiography screening and the incidence of postoperative MACE; a p-value < 0.05 was considered statistically significant. Results: The mean age was 72.5 ± 6.9, and the prevalence of cardiac risk factors was about 90%. The cumulative prevalence of iLVEF and valvopathy was higher after the screening (p < 0.001). The pEco-s diagnosed 25 new valvopathies: three of them were moderate-severe. No patients had MACE. Conclusions: pEco-s evaluation could discover unknown heart valve pathology; more studies are needed to understand if pEco-s could affect the anesthetic management of patients with functional limitations, preventing the incidence of MACE, and assessing its cost-effectiveness.
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Affiliation(s)
- Antonio Coviello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Dario Cirillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Andrea Uriel de Siena
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Maria Silvia Barone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Francesco Esposito
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Antonio Izzo
- Unit of Orthopedics and Traumatology, Department of Public Health, School of Medicine, “Federico II”—University of Naples, 80100 Naples, Italy;
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Serena Volpe
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Andrea Gabriele Stingone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
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Gorick C, Debski A. Mitochondrial transplantation for ischemic heart disease. NATURE NANOTECHNOLOGY 2024:10.1038/s41565-024-01678-2. [PMID: 38862713 DOI: 10.1038/s41565-024-01678-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Affiliation(s)
- Catherine Gorick
- University of Virginia, Department of Biomedical Engineering, Charlottesville, VA, USA.
| | - Anna Debski
- University of Virginia, Department of Biomedical Engineering, Charlottesville, VA, USA
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Demeke T, Hailemariam D, Santos P, Seife E, Addissie A, Sven Kroeber E, Mikolajczyk R, Silbersack B, Kantelhardt EJ, Unverzagt S. Willingness and ability to pay for breast cancer treatment among patients from Addis Ababa, Ethiopia: A cross-sectional study. PLoS One 2024; 19:e0300631. [PMID: 38547108 PMCID: PMC10977721 DOI: 10.1371/journal.pone.0300631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/02/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Breast cancer (BC) is the most common malignant neoplasm among women in Addis Ababa, Ethiopia. The willingness and ability to pay (WATP) for treatment is a contributing factor in the utilization of health care services. The World Health Organization Breast Cancer Initiative calls for 80% of patients to complete multimodality treatment and indicates payment as central factor to improve BC outcome. The objectives of this study are to identify how much female BC patients paid in Addis Ababa for BC treatment, their WATP for BC treatment, and the factors that affect WATP. METHODS The researchers collected data from 204 randomly selected BC patients who were treated in one of four different health facilities (one public and three private) between September 2018 and May 2019. A structured questionnaire was used to assess their WATP for BC treatment and multivariable regression to investigate factors associated with patients' WATP. RESULTS Of interviewed patients, 146 (72%) were at reproductive age. Patients' median expenditure for all BC treatment services was 336 US dollars (USD) in a public cancer center and 926 USD in privately owned health facilities. These amounts are in contrast with a reported WATP of 50 USD and 149 USD. WATP increased with increasing expenditure (OR 1.43; 95% CI 1.09 to 1.89 per 100 US), educational level (OR 1.37; 95% CI 1.02 to 1.85) and service quality (OR 1.34; 95% CI 1.04 to 1.72). In contrast, a monthly income increase by 100 USD corresponds to a 17% decrease of WATP (OR 0.83; 95% CI 0.70 to 0.99). CONCLUSIONS We demonstrated that BC treatment was very expensive for patients, and the cost was much higher than their WATP. Thus, we suggest that BC should be included in both social and community-based health insurance plans and treatment fees should consider patients' WATP.
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Affiliation(s)
- Tamiru Demeke
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global and Planetary Health Working Group, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Damen Hailemariam
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Pablo Santos
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Global and Planetary Health Working Group, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Edom Seife
- Radiotherapy Centre, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eric Sven Kroeber
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Global and Planetary Health Working Group, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute of General Practice and Family Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Birgit Silbersack
- Institute of General Practice and Family Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Global and Planetary Health Working Group, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Department of Gynecology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Susanne Unverzagt
- Global and Planetary Health Working Group, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute of General Practice and Family Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [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] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Chan CC, Tung Y, Lee K, Chan Y, Chu P. Clinical outcomes of generic versus brand-name clopidogrel for secondary prevention in patients with acute myocardial infarction: A nationwide cohort study. Clin Transl Sci 2023; 16:1594-1605. [PMID: 37448335 PMCID: PMC10499421 DOI: 10.1111/cts.13590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/19/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
Skepticism exists among healthcare workers and patients regarding the efficacy and safety of generic medication, despite its potential to lower healthcare costs. This study aimed to compare the outcomes of a generic clopidogrel and its brand-name counterpart for secondary prevention in patients with acute myocardial infarction (AMI). Using the Taiwan National Health Insurance Research Database, we identified 49,325 patients who were hospitalized for AMI between January 1, 2008 and December 31, 2013 and prescribed either generic or brand-name clopidogrel. Among them, 2419 (4.9%) were prescribed the generic clopidogrel. After propensity score matching, both the generic and brand-name groups consisted of 2382 patients. The primary efficacy outcome was a composite of myocardial infarction, coronary revascularization, ischemic stroke, and all-cause death. The primary safety outcome was major bleeding requiring hospitalization. At a mean follow-up of 2.5 years, the generic and brand-name clopidogrel groups had comparable risks of primary efficacy outcome (41.9% vs. 42%; hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.88-1.04), and the risks of the individual components were also similar. There were no significant differences between the two groups in major bleeding (7.9% vs. 7.9%; HR 0.99; 95% CI 0.81-1.21). Subgroup analyses also revealed no statistically significant interactions between the treatment effect and various subgroups. In this retrospective database analysis, the generic clopidogrel was comparable to its brand-name counterpart regarding cardiovascular and bleeding outcomes for the treatment of patients with AMI.
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Affiliation(s)
- Cze Ci Chan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
| | - Ying‐Chang Tung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
| | - Kuang‐Tso Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
| | - Yi‐Hsin Chan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
| | - Pao‐Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
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Bender U, Norris CM, Dreyer RP, Krumholz HM, Raparelli V, Pilote L. Impact of Sex- and Gender-Related Factors on Length of Stay Following Non-ST-Segment-Elevation Myocardial Infarction: A Multicountry Analysis. J Am Heart Assoc 2023; 12:e028553. [PMID: 37489737 PMCID: PMC10492965 DOI: 10.1161/jaha.122.028553] [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: 12/23/2022] [Accepted: 03/30/2023] [Indexed: 07/26/2023]
Abstract
Background Gender-related factors are psycho-socio-cultural characteristics and are associated with adverse clinical outcomes in acute myocardial infarction, independent of sex. Whether sex- and gender-related factors contribute to the substantial heterogeneity in hospital length of stay (LOS) among patients with non-ST-segment-elevation myocardial infarction remains unknown. Methods and Results This observational cohort study combined and analyzed data from the GENESIS-PRAXY (Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome study), EVA (Endocrine Vascular Disease Approach study), and VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI [Acute Myocardial Infarction] Patients study) cohorts of adults hospitalized across Canada, the United States, Switzerland, Italy, Spain, and Australia for non-ST-segment-elevation myocardial infarction. In total, 5219 participants were assessed for eligibility. Sixty-three patients were excluded for missing LOS, and 2938 were excluded because of no non-ST-segment-elevation myocardial infarction diagnosis. In total, 2218 participants were analyzed (66% women; mean±SD age, 48.5±7.9 years; 67.8% in the United States). Individuals with longer LOS (51%) were more likely to be White race, were more likely to have diabetes, hypertension, and a lower income, and were less likely to be employed and have completed secondary education. No univariate association between sex and LOS was observed. In the adjusted multivariable model, age (0.62 d/10 y; P<0.001), unemployment (0.63 days; P=0.01), and some of countries included relative to Canada (Italy, 4.1 days; Spain, 1.7 days; and the United States, -1.0 days; all P<0.001) were independently associated with longer LOS. Medical history mediated the effect of employment on LOS. No interaction between sex and employment was observed. Longer LOS was associated with increased 12-month all-cause mortality. Conclusions Older age, unemployment, and country of hospitalization were independent predictors of LOS, regardless of sex. Individuals employed with non-ST-segment-elevation myocardial infarction were more likely to experience shorter LOS. Sociocultural factors represent a potential target for improvement in health care expenditure and resource allocation.
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Affiliation(s)
- Uri Bender
- Department of Medicine, McGill University and Centre for Outcomes Research and EvaluationResearch Institute, McGill University Health CentreMontrealQuebecCanada
| | - Colleen M. Norris
- Faculties of Nursing, Medicine and School of Public HealthUniversity of AlbertaEdmontonCanada
| | - Rachel P. Dreyer
- Department of Emergency MedicineYale School of MedicineNew HavenCTUSA
- Center for Outcomes Research and EvaluationYale New Haven HospitalNew HavenCTUSA
- Department of BiostatisticsYale School of Public HealthNew HavenCTUSA
- Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenCTUSA
- Department of Health Policy and ManagementYale School of Public HealthNew HavenCTUSA
| | - Harlan M. Krumholz
- Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenCTUSA
- Department of Health Policy and ManagementYale School of Public HealthNew HavenCTUSA
| | - Valeria Raparelli
- Department of Translational MedicineUniversity of FerraraItaly
- University Center for Studies on Gender MedicineUniversity of FerraraItaly
| | - Louise Pilote
- Department of Medicine, McGill University and Centre for Outcomes Research and EvaluationResearch Institute, McGill University Health CentreMontrealQuebecCanada
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Balaha MF, Alamer AA, Kabel AM, Aldosari SA, Fatani S. A Prospective Cross-Sectional Study of Acute Coronary Syndrome Patients' Quality of Life and Drug Prescription Patterns at Riyadh Region Hospitals, Saudi Arabia. Healthcare (Basel) 2023; 11:1973. [PMID: 37444807 DOI: 10.3390/healthcare11131973] [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: 06/08/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023] Open
Abstract
Acute coronary syndrome (ACS) is a leading cause of cardiovascular-related morbidity and mortality worldwide. The present study investigated the health-related quality of life (HRQOL) and drug prescribing patterns in ACS patients at Riyadh hospitals in Saudi Arabia. This study was a 12-month prospective cross-sectional study that included 356 patients with ACS. The current study showed that younger male (67.42%) and urban (75.84%) patients suffered more from ACS. Moreover, most patients with NSTEMI (51.69%) experienced Grade 1 dyspnea (33.43%) and NYHA Stage 2 (29.80%); however, STEMI patients were at greater mortality risk. The HRQOL questionnaire showed that ACS patients were significantly impaired in all QOL domains (emotional [23.0%, p = 0.001], physical [24.4%, p = 0.003], and social [27.2%, p = 0.002]). Furthermore, the most commonly prescribed medications were statins (93%), antiplatelets (84%), anticoagulants (79%), coronary vasodilators (65%), and beta-blockers (63%). Additionally, 64% of patients received PCIs or CABGs, with the majority of cases receiving PCIs (49%), whereas 9% received dual anticoagulant therapy. Thus, there is an urgent need to educate healthcare teams about the relevance of QOL in ACS control and prevention and the new ACS management recommendations. ACS is also growing among younger people, requiring greater attention and prevention.
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Affiliation(s)
- Mohamed F Balaha
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
- Pharmacology Department, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Ahmed A Alamer
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Ahmed M Kabel
- Pharmacology Department, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Saad A Aldosari
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Sarah Fatani
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
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Enyeji AM, Barengo NC, Ibrahimou B, Ramirez G, Arrieta A. Association between Non-Dietary Cardiovascular Health and Expenditures Related to Acute Coronary Syndrome in the US between 2008-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095743. [PMID: 37174260 PMCID: PMC10178628 DOI: 10.3390/ijerph20095743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
Background: Acute Coronary Syndrome (ACS) causes the most deaths in the United States and accounts for the highest amount of healthcare spending. Cardiovascular Health (CVH) metrics have been widely used in primary prevention, but their benefits in secondary prevention on total healthcare expenditures related to ACS are largely unknown. This study aims to quantify the potential significance of ideal CVH scores as a tool in secondary cardiovascular disease prevention. Methods: In a cross-sectional analytical study, ten years of Medical Expenditure Panel Survey (MEPS) data from 2008 to 2018 were pooled, comparing ACS to non-ACS subgroups, utilizing a Two-part model with log link and gamma distribution, since our sample had both positive and zero costs. Conditional on positive expenditure, healthcare expenditure amounts were measured as a function of ACS status, socio-demographics, and CVH while controlling for relevant covariates. Finally, interactions of ACS with CVH metrics and other key variables were included to allow for variations in the effect of these variables on the two subgroups. Results: Improvements in CVH scores tended to reduce annual expenditures to a greater degree percentage-wise among ACS subjects compared to non-ACS groups, even though subjects with an ACS diagnosis tended to have approximately twice as big expenditures as similar subjects without an ACS diagnosis. Meanwhile, the financial impact of an ACS event on total expenditure would be approximately $88,500 ([95% CI, $70,200-106,900; p < 0.001]), and a unit improvement in CVH management score would generate savings of approximately $4160 ([95% CI, $5390-2950; p < 0.001]) in total health expenditures. Conclusions: Effective secondary preventive measures through targeted behavioral endeavors and improved health factors, especially the normalization of hypertension, diabetes mellitus, body mass index, and smoking cessation, have the potential to reduce medical spending for ACS subgroups.
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Affiliation(s)
- Abraham M Enyeji
- Department of Health Policy and Management, Robert Stempel College of Public Health & Social Works, Florida International University, Miami, FL 33174, USA
| | - Noël C Barengo
- Department of Health Policy and Management, Robert Stempel College of Public Health & Social Works, Florida International University, Miami, FL 33174, USA
- Division of Medical and Population Health Sciences Education and Research, Translational Medicine, Florida International University, Miami, FL 33199, USA
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
| | - Boubakari Ibrahimou
- Department of Biostatistics Robert Stempel, College of Public Health & Social Works, Florida International University, Miami, FL 33199, USA
| | - Gilbert Ramirez
- Department of Health Policy and Management, Robert Stempel College of Public Health & Social Works, Florida International University, Miami, FL 33174, USA
| | - Alejandro Arrieta
- Department of Health Policy and Management, Robert Stempel College of Public Health & Social Works, Florida International University, Miami, FL 33174, USA
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10
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Durand-Zaleski I, Ducrocq G, Mimouni M, Frenkiel J, Avendano-Solá C, Gonzalez-Juanatey JR, Ferrari E, Lemesle G, Puymirat E, Berard L, Cachanado M, Arnaiz JA, Martínez-Sellés M, Silvain J, Ariza-Solé A, Calvo G, Danchin N, Paco S, Drouet E, Abergel H, Rousseau A, Simon T, Steg PG. Economic evaluation of restrictive vs. liberal transfusion strategy following acute myocardial infarction (REALITY): trial-based cost-effectiveness and cost-utility analyses. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:194-202. [PMID: 35612990 DOI: 10.1093/ehjqcco/qcac029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 01/29/2023]
Abstract
AIMS To estimate the cost-effectiveness and cost-utility ratios of a restrictive vs. liberal transfusion strategy in acute myocardial infarction (AMI) patients with anaemia. METHODS AND RESULTS Patients (n = 666) with AMI and haemoglobin between 7-8 and 10 g/dL recruited in 35 hospitals in France and Spain were randomly assigned to a restrictive (n = 342) or a liberal (n = 324) transfusion strategy with 1-year prospective collection of resource utilization and quality of life using the EQ5D3L questionnaire. The economic evaluation was based on 648 patients from the per-protocol population. The outcomes were 30-day and 1-year cost-effectiveness, with major adverse cardiovascular events (MACEs) averted as the effectiveness outcome. and a 1-year cost-utility ratio.The 30-day incremental cost-effectiveness ratio was €33 065 saved per additional MACE averted with the restrictive vs. liberal strategy, with an 84% probability for the restrictive strategy to be cost-saving and MACE-reducing (i.e. dominant). At 1 year, the point estimate of the cost-utility ratio was €191 500 saved per quality-adjusted life year gained; however, the cumulated MACE was outside the pre-specified non-inferiority margin, resulting in a decremental cost-effectiveness ratio with a point estimate of €72 000 saved per additional MACE with the restrictive strategy. CONCLUSION In patients with AMI and anaemia, the restrictive transfusion strategy was dominant (cost-saving and outcome-improving) at 30 days. At 1 year, the restrictive strategy remained cost-saving, but clinical non-inferiority on MACE was no longer maintained. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02648113. ONE SENTENCE SUMMARY The use of a restrictive transfusion strategy in patients with acute myocardial infarction is associated with lower healthcare costs, but more evidence is needed to ascertain its long-term clinical impact.
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Affiliation(s)
- Isabelle Durand-Zaleski
- AP-HP Health Economics Research Unit, Hotel Dieu Hospital, place du parvis de Notre Dame 75004, Paris, France.,INSERM UMR 1153 CRESS, Paris, France
| | - Gregory Ducrocq
- Université de Paris, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, 75018, Paris, France
| | - Maroua Mimouni
- AP-HP Health Economics Research Unit, Hotel Dieu Hospital, place du parvis de Notre Dame 75004, Paris, France
| | - Jerome Frenkiel
- AP-HP Health Economics Research Unit, Hotel Dieu Hospital, place du parvis de Notre Dame 75004, Paris, France
| | - Cristina Avendano-Solá
- Clinical Pharmacology Service, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Jose R Gonzalez-Juanatey
- Cardiology Department, University Hospital, IDIS, CIBERCV, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Emile Ferrari
- Université Côte d'Azur, and CHU de Nice, Hôpital Pasteur 1, Service de Cardiologie, 06001, Nice, France
| | - Gilles Lemesle
- Institut Cœur Poumon, Centre Hospitalier Universitaire de Lille, Faculté de Médecine de Lille, Université de Lille, Institut Pasteur de Lille, Inserm U1011, F-59000 Lille, France
| | - Etienne Puymirat
- Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, French Alliance for Cardiovascular Trials (FACT), 75015, Paris, France
| | - Laurence Berard
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, 75012, Paris, France
| | - Marine Cachanado
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, 75012, Paris, France
| | - Joan Albert Arnaiz
- Clinical Trials Unit, Clinical Pharmacology Department, Hospital Clinic, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, and Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, 75013, Paris, France
| | - Albert Ariza-Solé
- University Hospital Bellvitge, Heart Disease Institute, Barcelona, Spain
| | - Gonzalo Calvo
- Àrea del Medicament, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Nicolas Danchin
- Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, French Alliance for Cardiovascular Trials (FACT), 75015, Paris, France
| | - Sandra Paco
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, 75012, Paris, France
| | - Elodie Drouet
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, 75012, Paris, France
| | - Helene Abergel
- Université de Paris, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, 75018, Paris, France
| | - Alexandra Rousseau
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, 75012, Paris, France
| | - Tabassome Simon
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, 75012, Paris, France
| | - Philippe Gabriel Steg
- Université de Paris, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, 75018, Paris, France
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11
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1190] [Impact Index Per Article: 1190.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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12
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Mallow PJ, Browne F, Shemisa K. The High Cost of Death After Acute Myocardial Infarctions: Results from a National US Hospital Database. Clinicoecon Outcomes Res 2023; 15:63-68. [PMID: 36747496 PMCID: PMC9899015 DOI: 10.2147/ceor.s397220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/21/2023] [Indexed: 02/01/2023]
Abstract
Introduction This study described the differences in costs and length of stay (LOS) among patients with AMI who died versus survived using a large, nationally representative cohort of AMI patients. Methods The 2019 HCUP NIS was used to analyze costs, and LOS among all patients with a principal diagnosis of AMI. A propensity-score matched analysis and multivariable regression were used to adjust for patient and hospital characteristics. Results There were 4559 visits in each of the cohorts (total 9118). The adjusted mean hospital cost was $18,970 (95% CI $16,453 - $21,871) for those that survived and $23,173 (95% CI $20,167 - $26,626; p <0.001) for those that died. The LOS was 3.95 (95% CI 3.41-4.57) in survivors and 4.24 (95% CI 3.67-4.89; p <0.001) in those who died. Conclusion Survivors of AMI incurred lower costs and length of stay than those who died. Higher costs were attributed to greater LOS and higher-level care. The results suggest that economic evaluations of cardiovascular interventions that do not include the cost of dying may underestimate the benefits of the intervention.
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Affiliation(s)
- Peter J Mallow
- Health Services Administration, Xavier University, Cincinnati, OH, USA,Correspondence: Peter J Mallow, Email
| | - Frederick Browne
- Health Services Administration, Xavier University, Cincinnati, OH, USA
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13
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Nanna MG, Abdullah A, Mortensen MB, Navar AM. Primary prevention statin therapy in older adults. Curr Opin Cardiol 2023; 38:11-20. [PMID: 36598445 PMCID: PMC9830552 DOI: 10.1097/hco.0000000000001003] [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] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to assess the evidence for primary prevention statin treatment in older adults, within the context of the most recent guideline recommendations, while also highlighting important considerations for shared decision-making. RECENT FINDINGS As the average lifespan increases and the older adult population grows, the opportunity for prevention of morbidity and mortality from cardiovascular disease is magnified. Randomized trials and meta-analyses have demonstrated a clear benefit for primary prevention statin use through age 75, with uncertainty beyond that age. Despite these data supporting their use, current guidelines conflict in their statin treatment recommendations in those aged 70-75 years. Reflecting the paucity of evidence, the same guidelines are equivocal around primary prevention statins in those beyond age 75. Two large ongoing randomized trials (STAREE and PREVENTABLE) will provide additional insights into the treatment benefits and risks of primary prevention statins in the older adult population. In the meantime, a holistic approach in treatment decisions remains paramount for older patients. SUMMARY The benefits of primary prevention statin treatment are apparent through age 75, which is reflected in the current ACC/AHA and USPSTF recommendations. Ongoing trials will clarify the utility in those beyond age 75.
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Affiliation(s)
- Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ahmed Abdullah
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Ann Marie Navar
- Division of Cardiology, UT Southwestern Medical Center, Dallas, Texas, USA
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14
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You L, Wang Q, Ma Y, Li Y, Ye H, Xu L, Lei M. Precise dapagliflozin delivery by cardiac homing peptide functionalized mesoporous silica nanocarries for heart failure repair after myocardial infarction. Front Chem 2022; 10:1013910. [PMID: 36405311 PMCID: PMC9671955 DOI: 10.3389/fchem.2022.1013910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Myocardial infarction (MI) may cause irreversible damage or destroy to part of the heart muscle, affecting the heart’s ability and power to pump blood as efficiently as before, often resulting in heart failure (HF). Cardiomyocyte death and scar formation after MI may then trigger chronic neurohormonal activation and ventricular remodeling. We developed a biocompatible and mono-dispersed mesoporous silica nanoparticles (MSN) divergent porous channel for dapagliflozin (DAPA) loading. After surface modification of the cardiac-targeting peptides, the novel drug delivery system was successfully homed, and precisely released drugs for the hypoxic and weak acid damaged cardiomyocytes. Our biocompatible MSN- based nanocarriers for dapagliflozin delivery system could effective cardiac repair and regeneration in vivo, opening new opportunities for healing patients with ischemic heart disease in clinical.
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Affiliation(s)
| | | | | | | | | | - Lingli Xu
- *Correspondence: Lingli Xu, ; Ming Lei,
| | - Ming Lei
- *Correspondence: Lingli Xu, ; Ming Lei,
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15
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Early risk assessment in patients with suspected NSTE-ACS; a retrospective cohort study. Am J Emerg Med 2022; 60:106-115. [PMID: 35939854 DOI: 10.1016/j.ajem.2022.07.053] [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: 04/28/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Chest pain is among the most common reasons for Emergency Department (ED) presentation, while most patients should be considered low risk for Acute Coronary Syndrome (ACS). Management of these patients places a significant burden on our health care system. Various risk scores have been developed to facilitate the triage of patients with chest pain. However, it remains unclear which score performs best in identifying low risk patients, in various settings. The aim of this study was to determine which risk score performs best in ruling out non-ST elevation ACS (NSTE-ACS). METHODS Data was collected from all patients >18 years presenting to the ED between 01 and 01-2019 and 01-07-2019, if they were suspected of NSTE-ACS. Primary endpoint was NSTE-ACS during presentation to the ED or hospitalization, according to the 2020 ESC guidelines. In a secondary analysis we determined the number low-risk patients, at set safety levels of 95% and 98%. RESULTS A total of 536 patients were included, 192 (35.9%) were admitted to the hospital and NSTE-ACS occurred in 134 of 536 patients (25.0%). When areas under the curve (AUC) were compared, pre-HEART (0.869; CI 0.835-0.903), T-MACS (0.862; CI 0.825-0.898) and HEART (0.850; CI 0.815-0.885) performed best. At a safety level of 98%, the HEART score was the best performing risk score and identified 28.9% of patients as low risk, and missed 0 cases of NSTE-ACS. Followed by the pre-HEART score, which identified 18.3% of all patients as low risk, and missed 0% of NSTE-ACS. CONCLUSIONS The newly developed pre-HEART score is both practical and has accurate diagnostic properties, closely followed by the HEART score, and T-MACS. New pre-hospital risk scores are promising and much needed. Future studies should focus on the usage of pre-hospital scores for triage of patients with chest pain, in order to reduce the burden on emergency health care.
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16
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Beauchamp A, Talevski J, Nicholls SJ, Wong Shee A, Martin C, Van Gaal W, Oqueli E, Ananthapavan J, Sharma L, O'Neil A, Brennan-Olsen SL, Jessup RL. Health literacy and long-term health outcomes following myocardial infarction: protocol for a multicentre, prospective cohort study (ENHEARTEN study). BMJ Open 2022; 12:e060480. [PMID: 35523501 PMCID: PMC9083432 DOI: 10.1136/bmjopen-2021-060480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Low health literacy is common in people with cardiovascular disease and may be one factor that affects an individual's ability to maintain secondary prevention health behaviours following myocardial infarction (MI). However, little is known about the association between health literacy and longer-term health outcomes in people with MI. The ENhancing HEAlth literacy in secondary pRevenTion of cardiac evENts (ENHEARTEN) study aims to examine the relationship between health literacy and a number of health outcomes (including healthcare costs) in a cohort of patients following their first MI. Findings may provide evidence for the significance of health literacy as a predictor of long-term cardiac outcomes. METHODS AND ANALYSIS ENHEARTEN is a multicentre, prospective observational study in a convenience sample of adults (aged >18 years) with their first MI. A total of 450 patients will be recruited over 2 years across two metropolitan health services and one rural/regional health service in Victoria, Australia. The primary outcome of this study will be all-cause, unplanned hospital admissions within 6 months of index admission. Secondary outcomes include cardiac-related hospital admissions up to 24 months post-MI, emergency department presentations, health-related quality of life, mortality, cardiac rehabilitation attendance and healthcare costs. Health literacy will be observed as a predictor variable and will be determined using the 12-item version of the European Health Literacy Survey (HLS-Q12). ETHICS AND DISSEMINATION Ethics approval for this study has been received from the relevant human research ethics committee (HREC) at each of the participating health services (lead site Monash Health HREC; approval number: RES-21-0000-242A) and Services Australia HREC (reference number: RMS1672). Informed written consent will be sought from all participants. Study results will be published in peer-reviewed journals and collated in reports for participating health services and participants. TRIAL REGISTRATION NUMBER ACTRN12621001224819.
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Affiliation(s)
- Alison Beauchamp
- School of Rural Health, Monash University, Warragul, Victoria, Australia
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jason Talevski
- School of Rural Health, Monash University, Warragul, Victoria, Australia
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
| | - Anna Wong Shee
- Allied Health, Ballarat Health Services - Grampians Health, Ballarat, Victoria, Australia
- Deakin Rural Health, Deakin University, Ballarat, Victoria, Australia
| | - Catherine Martin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Data Science and AI, Monash University, Melbourne, Victoria, Australia
| | - William Van Gaal
- Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of Cardiology, The Northern Hospital, Melbourne, Victoria, Australia
| | - Ernesto Oqueli
- School of Medicine, Deakin University, Burwood, Victoria, Australia
- Cardiology, Ballarat Health Services - Grampians Health, Ballarat, Vic, Australia
| | - Jaithri Ananthapavan
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Laveena Sharma
- School of Rural Health, Monash University, Warragul, Victoria, Australia
- Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Adrienne O'Neil
- Institute for Mental and Physical Health and Clinical Training, Food & Mood Centre, Deakin University, Geelong, Victoria, 3220
| | - Sharon Lee Brennan-Olsen
- School of Health and Social Development, Deakin University - Geelong Waterfront Campus, Geelong, Victoria, Australia
| | - Rebecca Leigh Jessup
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Staying Well Programs, Northern Health, Melbourne, Victoria, Australia
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17
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Association between periodontal care and hospitalization with acute myocardial infarction. J Am Dent Assoc 2022; 153:776-786.e2. [PMID: 35459524 DOI: 10.1016/j.adaj.2022.02.003] [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: 10/04/2021] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Each year there are 800,000 myocardial infarctions in the United States. There is an increased risk of hospitalization for acute myocardial infarction (AMI) for those with periodontal disease. Yet, there is a paucity of knowledge about downstream care of AMI and how this varies with periodontal care status. The authors' aim was to examine the association between periodontal care and AMI hospitalization and 30 days after acute care. METHODS Using the MarketScan database, the authors conducted a retrospective cohort study among patients with both dental insurance and medical insurance in 2016 through 2018 who were hospitalized for AMI in 2017. RESULTS There were 2,370 patients who had dental and medical coverage for 2016 through 2018 and received oral health care in 2016 through 2017 and had an AMI hospitalization in 2017. Forty-seven percent received regular or other oral health care, 7% received active periodontal care, and 10% received controlled periodontal care. More than one-third of patients (36%) did not have oral health care before the AMI hospitalization. After adjusting for patient characteristics, we found that patients in the controlled periodontal care group were significantly more likely to have visits during the 30 days after AMI hospitalization (adjusted odds ratio, 1.63; 95% CI, 1.07 to 2.47; P = .02). CONCLUSIONS We found that periodontal care was associated with more after AMI visits. This suggests that there is a benefit to incorporating oral health care and medical care to improve AMI outcomes. PRACTICAL IMPLICATIONS Needing periodontal care is associated with more favorable outcomes related to AMI hospitalization. Early intervention to ensure stable periodontal health in patients with risk factors for AMI could reduce downstream hospital resource use.
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18
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Hofmann R, Abebe TB, Herlitz J, James SK, Erlinge D, Alfredsson J, Jernberg T, Kellerth T, Ravn-Fischer A, Lindahl B, Langenskiöld S. Avoiding Routine Oxygen Therapy in Patients With Myocardial Infarction Saves Significant Expenditure for the Health Care System-Insights From the Randomized DETO2X-AMI Trial. Front Public Health 2022; 9:711222. [PMID: 35096723 PMCID: PMC8790120 DOI: 10.3389/fpubh.2021.711222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Myocardial infarction (MI) occurs frequently and requires considerable health care resources. It is important to ensure that the treatments which are provided are both clinically effective and economically justifiable. Based on recent new evidence, routine oxygen therapy is no longer recommended in MI patients without hypoxemia. By using data from a nationwide randomized clinical trial, we estimated oxygen therapy related cost savings in this important clinical setting. Methods: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial randomized 6,629 patients from 35 hospitals across Sweden to oxygen at 6 L/min for 6–12 h or ambient air. Costs for drug and medical supplies, and labor were calculated per patient, for the whole study population, and for the total annual care episodes for MI in Sweden (N = 16,100) with 10 million inhabitants. Results: Per patient, costs were estimated to 36 USD, summing up to a total cost of 119,832 USD for the whole study population allocated to oxygen treatment. Applied to the annual care episodes for MI in Sweden, costs sum up to between 514,060 and 604,777 USD. In the trial, 62 (2%) patients assigned to oxygen and 254 (8%) patients assigned to ambient air developed hypoxemia. A threshold analysis suggested that up to a cut-off of 624 USD spent for hypoxemia treatment related costs per patient, avoiding routine oxygen therapy remains cost saving. Conclusions: Avoiding routine oxygen therapy in patients with suspected or confirmed MI without hypoxemia at baseline saves significant expenditure for the health care system both with regards to medical and human resources. Clinical Trial Registration:ClinicalTrials.gov, identifier: NCT01787110.
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Affiliation(s)
- Robin Hofmann
- Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | | | - Johan Herlitz
- Department of Health Sciences, University of Borås, Borås, Sweden
| | - Stefan K James
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - David Erlinge
- Department of Clinical Sciences, Cardiology, Lund University, Lund, Sweden
| | - Joakim Alfredsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Cardiology, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Thomas Kellerth
- Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Annica Ravn-Fischer
- Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Cardiology, University of Gothenburg, Gothenburg, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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19
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The Association of Cannabis Use Disorder and Perioperative Complications After Primary Total Knee Arthroplasty. J Am Acad Orthop Surg 2022; 30:313-320. [PMID: 35171881 DOI: 10.5435/jaaos-d-21-00703] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/09/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Although studies have shown the implications of substance use on total joint arthroplasty, studies investigating the association of patients exclusively who have cannabis use disorder (CUD) after primary total knee arthroplasty (TKA) are sparse. As such, this study analyzed a private payor database to assess the relationship of CUD after primary TKA. METHODS Data from the Mariner data set were used to identify patients who have CUD undergoing primary TKA. Patients with CUD were ratio matched 1:5 to a comparison population by age, sex, and comorbidities, yielding 55,553 patients in the study (n = 9,260) and case-matched (n = 46,293) population. Variables compared included in-hospital length of stay, complications, and costs. A P value of less than 0.003 was considered statistically significant. RESULTS Patients with CUD were found to have longer in-hospital length of stay (3.61 versus 2.07 days, P < 0.0001), in addition to higher frequency and odds ratio (OR) of medical (28.08 versus 12.5; OR, 1.50, P < 0.0001) and prostheses-related complications (9.63 versus 5.16%; OR, 1.56, P < 0.0001). Patients with CUD also incurred significantly higher episode of care costs ($29,025.34 versus $24,258.17, P < 0.0001). CONCLUSION With the continued legalization of cannabis use across the United States, studies investigating the association of cannabis on outcomes after primary TKA are limited. The current study helps to expand the current literature on outcomes of substance abuse after total joint arthroplasty and can serve to help educate patients of potential complications after their TKA.
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20
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2414] [Impact Index Per Article: 1207.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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21
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Chien SC, Hsu CY, Liu HY, Lin CF, Hung CL, Huang CY, Chien LN. Cardiogenic shock in Taiwan from 2003 to 2017 (CSiT-15 study). Crit Care 2021; 25:402. [PMID: 34794502 PMCID: PMC8600726 DOI: 10.1186/s13054-021-03820-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study investigated temporal trends in the treatment and mortality of patients with cardiogenic shock (CS) in Taiwan in relation to acute myocardial infarction (AMI) accreditation implemented in 2009 and the unavailability of percutaneous ventricular assist devices. METHODS Data of patients diagnosed as having CS between January 2003 and December 2017 were collected from Taiwan's National Health Insurance Research Database. Each case was followed from the date of emergency department arrival or hospital admission for the first incident associated with a CS diagnosis up to a 1-year interval. Measurements included demographics, comorbidities, treatment, mortality, and medical costs. Using an interrupted time-series (ITS) design with multi-level mixed-effects logistic regression model, we assessed the impact of AMI accreditation implementation on the mortality of patients with AMI and CS overall and stratified by the hospital levels. RESULTS In total, 64 049 patients with CS (mean age:70 years; 62% men) were identified. The incidence rate per 105 person-years increased from 17 in 2003 to 25 in 2010 and plateaued thereafter. Average inpatient costs increased from 159 125 points in 2003 to 240 993 points in 2017, indicating a 1.5-fold increase. The intra-aortic balloon pump application rate was approximately 22-25% after 2010 (p = 0.093). Overall, in-hospital, 30-day, and 1-year mortality declined from 60.3%, 63.0%, and 69.3% in 2003 to 47.9%, 50.8% and 59.8% in 2017, respectively. The decline in mortality was more apparent in patients with AMI-CS than in patients with non-AMI-CS. The ITS estimation revealed a 2% lower in-hospital mortality in patients with AMI-CS treated in district hospitals after the AMI accreditation had been implemented for 2 years. CONCLUSIONS In Taiwan, the burden of CS has consistently increased due to high patient complexity, advanced therapies, and stable incidence. Mortality declined over time, particularly in patients with AMI-CS, which may be attributable to advancements in AMI therapies and this quality-improving policy.
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Affiliation(s)
- Shih-Chieh Chien
- Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chien-Yi Hsu
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Hung-Yi Liu
- Health Data Analytics and Statistics Center, Office of Data Science, Taipei Medical University, No. 250 Wuxing Street, Taipei, Taiwan
| | - Chao-Feng Lin
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chung-Lieh Hung
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chun-Yao Huang
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Li-Nien Chien
- Health Data Analytics and Statistics Center, Office of Data Science, Taipei Medical University, No. 250 Wuxing Street, Taipei, Taiwan. .,School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.
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22
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Hess CN, Debus ES, Nehler MR, Anand SS, Patel MR, Szarek M, Capell WH, Hsia J, Beckman JA, Brodmann M, Diaz R, Habertheuer P, Leeper NJ, Powell RJ, Sillesen H, Muehlhofer E, Berkowitz SD, Haskell LP, Bauersachs RM, Bonaca MP. Reduction in Acute Limb Ischemia with Rivaroxaban versus Placebo in Peripheral Artery Disease after Lower Extremity Revascularization: Insights from VOYAGER PAD. Circulation 2021; 144:1831-1841. [PMID: 34637332 DOI: 10.1161/circulationaha.121.055146] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Patients with peripheral artery disease (PAD) are at heightened risk of acute limb ischemia (ALI), a thrombotic event associated with amputation, disability, and mortality. Prior lower extremity revascularization (LER) is associated with increased ALI risk in chronic PAD. However, the pattern of risk, clinical correlates, and outcomes after ALI early after LER are not well-studied, and effective therapies to reduce ALI post-LER are lacking. Methods: VOYAGER PAD (NCT02504216) randomized patients with PAD undergoing LER to rivaroxaban 2.5 mg twice daily or placebo on a background of low-dose aspirin. The primary outcome was a composite of ALI, major amputation of vascular cause, myocardial infarction, ischemic stroke, or cardiovascular death. ALI was prospectively ascertained and adjudicated by a blinded committee. The cumulative incidence of ALI was calculated using Kaplan Meier estimates, and Cox proportional-hazards models were used to generate hazard ratios and associated confidence intervals. Analyses were performed as intention-to-treat. Results: Among 6,564 patients followed for a median of 2.3 years, 382 (5.8%) had a total of 508 ALI events. In placebo patients, the 3-year cumulative incidence of ALI was 7.8%. After multivariable modeling, prior LER, baseline ABI <0.50, surgical LER, and longer target lesion length were associated with increased risk of ALI. Incident ALI was associated with subsequent all-cause mortality (HR 2.59, 95% CI 1.98-3.39) and major amputation (HR 24.87, 95% CI 18.68-33.12). Rivaroxaban reduced ALI relative to placebo by 33% (absolute risk reduction 2.6% at 3 years, HR 0.67, 95% CI 0.55-0.82, P=0.0001), with benefit starting early (HR 0.45, 95% CI 0.24-0.85, P=0.0068 at 30 days). Benefit was present for severe ALI (associated with death, amputation, or prolonged hospitalization and ICU stay, HR 0.58, 95% CI 0.40-0.83, P=0.003) and regardless of LER type (surgical vs endovascular revascularization, p-interaction=0.42) or clopidogrel use (p-interaction=0.59). Conclusions: After LER for symptomatic PAD, ALI is frequent, particularly early after LER, and is associated with poor prognosis. Low-dose rivaroxaban plus aspirin reduces ALI after LER, including ALI events associated with the most severe outcomes. The benefit of rivaroxaban for ALI appears early, continues over time, and is consistent regardless of revascularization approach or clopidogrel use.
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Affiliation(s)
- Connie N Hess
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO; CPC Clinical Research, Aurora, CO
| | - E Sebastian Debus
- Department of Vascular Medicine, Vascular Surgery - Angiology - Endovascular Therapy, University of Hamburg-Eppendorf, Hamburg, Germany
| | - Mark R Nehler
- CPC Clinical Research, Aurora, CO; University of Colorado School of Medicine, Department of Surgery, Aurora, CO
| | - Sonia S Anand
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Manesh R Patel
- Duke Clinical Research Institute, Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Michael Szarek
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO; CPC Clinical Research, Aurora, CO; The State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Warren H Capell
- CPC Clinical Research, Aurora, CO; Department of Medicine, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Judith Hsia
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO; CPC Clinical Research, Aurora, CO
| | - Joshua A Beckman
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN
| | | | - Rafael Diaz
- Instituto Cardiovascular de Rosario, Rosario, Argentina
| | | | - Nicholas J Leeper
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford CA
| | - Richard J Powell
- Section of Vascular Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Denmark
| | | | | | | | - Rupert M Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt, Darmstadt, and Center for Thrombosis and Hemostasis, University of Mainz, Mainz
| | - Marc P Bonaca
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO; CPC Clinical Research, Aurora, CO
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23
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Duffy EY, Ashen D, Blumenthal RS, Davis DM, Gulati M, Blaha MJ, Michos ED, Nasir K, Cainzos‐Achirica M. Communication approaches to enhance patient motivation and adherence in cardiovascular disease prevention. Clin Cardiol 2021; 44:1199-1207. [PMID: 34414588 PMCID: PMC8427972 DOI: 10.1002/clc.23555] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 12/25/2022] Open
Abstract
Preventive cardiology visits have traditionally focused on educating patients about disease risk factors and the need to avoid and manage them through lifestyle changes and medications. However, long-term patient adherence to the recommended interventions remains a key unmet need. In this review we discuss the rationale and potential benefits of a paradigm shift in the clinician-patient encounter, from focusing on education to explicitly discussing key drivers of individual motivation. This includes the emotional, psychological, and economic mindset that patients bring to their health decisions. Five communication approaches are proposed that progress clinician-patient preventive cardiology conversations, from provision of information to addressing values and priorities such as common health concerns, love for the family, desire of social recognition, financial stressors, and desire to receive personalized advice. Although further research is needed, these approaches may facilitate developing deeper, more effective bonds with patients, enhance adherence to recommendations and ultimately, improve cardiovascular outcomes.
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Affiliation(s)
- Eamon Y. Duffy
- Department of Internal MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Dominique Ashen
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- School of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Dorothy M. Davis
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- School of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Martha Gulati
- University of Arizona College of MedicinePhoenixArizonaUSA
- Banner University Medical CenterPhoenixArizonaUSA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public Health, Johns Hopkins UniversityBaltimoreMarylandUSA
| | - Erin D. Michos
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public Health, Johns Hopkins UniversityBaltimoreMarylandUSA
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Division of Cardiovascular Prevention and Wellness, Department of CardiologyHouston Methodist DeBakey Heart & Vascular CenterHoustonTexasUSA
- Center for Outcomes ResearchHouston MethodistHoustonTexasUSA
| | - Miguel Cainzos‐Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Division of Cardiovascular Prevention and Wellness, Department of CardiologyHouston Methodist DeBakey Heart & Vascular CenterHoustonTexasUSA
- Center for Outcomes ResearchHouston MethodistHoustonTexasUSA
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24
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Lin C, Liu H, Liu X, Zhang Y, Wu F. The application of whole-course nursing in patients undergoing emergency PCI and its impact on cardiac function. Am J Transl Res 2021; 13:8323-8329. [PMID: 34377323 PMCID: PMC8340182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To implement whole-course care in patients undergoing emergency percutaneous coronary intervention and investigate its impact on cardiac function. METHODS This study included 88 acute myocardial infarction patients undergoing percutaneous coronary intervention. These patients were randomly divided into the control group (n=44, which underwent routine care) and the experimental group (n=44, which underwent whole-course care). The cardiac function, physiological states, quality of life, complications, and the patient satisfaction with the care were compared between the two groups. RESULTS Compared with before the surgery, the left ventricular ejection fractions and the cardiac output in both groups at discharge were increased, while the left ventricular end-systolic diameters and left ventricular end-diastolic diameters were decreased (all P<0.05). In addition, the changes in the experimental group were greater than they were in the control group (all P<0.05). The HAMA and HAMD scores in the two groups at discharge were decreased compared with before the surgeries, but the GQOLI-74 scores in all aspects were increased (all P<0.05). Similarly, the changes in the experimental group were greater than those in the control group (all P<0.05). The incidence of postoperative complications in the experimental group was lower than it was in the control group, and the satisfaction with care was higher than it was in the control group (both P<0.05). CONCLUSIONS The whole-course care of AMI patients undergoing PCI can significantly relieve their negative emotions, improve their cardiac function, increase their quality of life, and reduce their incidences of complications.
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Affiliation(s)
- Caixia Lin
- Department of Nursing, Quanzhou First Hospital Affiliated to Fujian Medical UniversityQuanzhou, Fujian Province, China
| | - Haijin Liu
- Department of Emergency, Quanzhou First Hospital Affiliated to Fujian Medical UniversityQuanzhou, Fujian Province, China
| | - Xiarong Liu
- Department of Emergency, Quanzhou First Hospital Affiliated to Fujian Medical UniversityQuanzhou, Fujian Province, China
| | - Yumei Zhang
- Department of Cardiology, Quanzhou First Hospital Affiliated to Fujian Medical UniversityQuanzhou, Fujian Province, China
| | - Fenfen Wu
- Department of Nursing, Quanzhou First Hospital Affiliated to Fujian Medical UniversityQuanzhou, Fujian Province, China
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25
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Azul Freitas A, Baptista R, Gonçalves V, Ferreira C, Milner J, Lourenço C, Costa S, Franco F, Monteiro S, Gonçalves F, Gonçalves L. Impact of SARS-CoV-2 pandemic on ST-elevation myocardial infarction admissions and outcomes in a Portuguese primary percutaneous coronary intervention center: Preliminary Data. Rev Port Cardiol 2021; 40:465-471. [PMID: 34629724 PMCID: PMC7980184 DOI: 10.1016/j.repc.2020.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/13/2020] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION Coronavirus disease (COVID-19) has led to significant changes in healthcare systems and its impact on the treatment of cardiovascular conditions, such as ST-elevation myocardial infarction (STEMI), is unknown in countries where the healthcare systems were not saturated, as was the case in Portugal. As such, we aimed to assess the effect on STEMI admissions and outcomes in Portuguese centers. METHODS We conducted a single-center, observational, retrospective study including all patients admitted to our hospital due to STEMI between the date of the first SARS-CoV-2 case diagnosed in Portugal and the end of the state of emergency (March and April 2020). Patient characteristics and outcomes were assessed and compared with the same period of 2019. RESULTS A total of 104 STEMI patients were assessed, 55 in 2019 and 49 in 2020 (-11%). There were no significant differences between groups regarding age (62±12 vs. 65±14 years, p=0.308), gender (84.8% vs. 77.6% males, p=0.295) or comorbidities. In the 2020 group, there was a significant decrease in the proportion of patients transported to the hospital in pre-hospital emergency medical transportation (38.2% vs. 20.4%, p=0.038), an increase in system delay (49 [30-110.25] vs. 140 [90-180] minutes, p=0.019), a higher Killip-Kimball class, with a decrease in class I (74.5% vs. 51%) and an increase in class III (1.8% vs. 8.2%) and IV (5.5% vs. 18.4%) (p=0.038), a greater incidence of vasoactive support (3.7% vs. 26.5%, p=0.001), invasive mechanic ventilation usage (3.6% vs. 14.3%, p=0.056), and an increase in severe left ventricular dysfunction at hospital discharge (3.6% vs. 16.3%, p=0.03). In-hospital mortality was 14.3% in the 2020 group and 7.3% in the 2019 group p=0.200). CONCLUSION Despite a lack of significant variation in the absolute number of STEMI admissions, there was an increase in STEMI clinical severity and significantly worse outcomes during the SARS-CoV-2 pandemic. An increase in system delay, impaired pre-hospital care and patient fear of in-hospital infection can partially justify these results and should be the target of future actions in further waves of the pandemic.
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Affiliation(s)
- André Azul Freitas
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rui Baptista
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Valdirene Gonçalves
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cátia Ferreira
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - James Milner
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carolina Lourenço
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Susana Costa
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Fátima Franco
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sílvia Monteiro
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Francisco Gonçalves
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
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26
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Azul Freitas A, Baptista R, Gonçalves V, Ferreira C, Milner J, Lourenço C, Costa S, Franco F, Monteiro S, Gonçalves F, Gonçalves L. Impact of SARS-CoV-2 pandemic on ST-elevation myocardial infarction admissions and outcomes in a Portuguese primary percutaneous coronary intervention center: Preliminary Data. Rev Port Cardiol 2021; 40:465-471. [PMID: 34274091 PMCID: PMC8278193 DOI: 10.1016/j.repce.2021.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Coronavirus disease (COVID-19) has led to significant changes in healthcare systems and its impact on the treatment of cardiovascular conditions, such as ST-elevation myocardial infarction (STEMI), is unknown in countries where the healthcare systems were not saturated, as was the case in Portugal. As such, we aimed to assess the effect on STEMI admissions and outcomes in Portuguese centers. METHODS We conducted a single-center, observational, retrospective study including all patients admitted to our hospital due to STEMI between the date of the first SARS-CoV-2 case diagnosed in Portugal and the end of the state of emergency (March and April 2020). Patient characteristics and outcomes were assessed and compared with the same period of 2019. RESULTS A total of 104 STEMI patients were assessed, 55 in 2019 and 49 in 2020 (-11%). There were no significant differences between groups regarding age (62±12 vs. 65±14 years, p=0.308), gender (84.8% vs. 77.6% males, p=0.295) or comorbidities. In the 2020 group, there was a significant decrease in the proportion of patients transported to the hospital in pre-hospital emergency medical transportation (38.2% vs. 20.4%, p=0.038), an increase in system delay (49 [30-110.25] vs. 140 [90-180] minutes, p=0.019), a higher Killip-Kimball class, with a decrease in class I (74.5% vs. 51%) and an increase in class III (1.8% vs. 8.2%) and IV (5.5% vs. 18.4%) (p=0.038), a greater incidence of vasoactive support (3.7% vs. 26.5%, p=0.001), invasive mechanic ventilation usage (3.6% vs. 14.3%, p=0.056), and an increase in severe left ventricular dysfunction at hospital discharge (3.6% vs. 16.3%, p=0.03). In-hospital mortality was 14.3% in the 2020 group and 7.3% in the 2019 group p=0.200). CONCLUSION Despite a lack of significant variation in the absolute number of STEMI admissions, there was an increase in STEMI clinical severity and significantly worse outcomes during the SARS-CoV-2 pandemic. An increase in system delay, impaired pre-hospital care and patient fear of in-hospital infection can partially justify these results and should be the target of future actions in further waves of the pandemic.
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Affiliation(s)
- André Azul Freitas
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Rui Baptista
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal; Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Valdirene Gonçalves
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cátia Ferreira
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - James Milner
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carolina Lourenço
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Susana Costa
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Fátima Franco
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sílvia Monteiro
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Francisco Gonçalves
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal; Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
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Cui C, Ramakrishnan G, Murphy J, Malas MB. Cost-Effectiveness of TransCarotid Artery Revascularization versus Carotid Endarterectomy. J Vasc Surg 2021; 74:1910-1918.e3. [PMID: 34182030 DOI: 10.1016/j.jvs.2021.05.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 05/17/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Recent studies have demonstrated that TransCarotid Artery Stenting (TCAR) has comparable outcomes to the surgical gold standard, carotid endarterectomy (CEA). However, few studies have analyzed the cost of TCAR and no study has evaluated its cost-effectiveness. The purpose of this study is to conduct a cost-effectiveness analysis comparing TCAR to CEA for carotid artery stenosis. METHODS We built a Markov microsimulation using transition probabilities and utilities from existing literature for symptomatic patients undergoing TCAR or CEA. Costs were derived from literature then converted to 2019 dollars. The model included six health states with monthly cycle lengths: surgery, death, alive after surgery, alive after myocardial infarction, alive after stroke, and alive after stroke and death. Quality adjusted life years (QALYs), costs, and incremental cost-effectiveness ratio (ICER) were analyzed over a five-year period. One-way sensitivity and probabilistic sensitivity analyses were conducted to study the impact of parameter variability on cost effectiveness. RESULTS For symptomatic patients, CEA cost $7821 for 2.85 QALYs while TCAR cost $19154 for 2. 92 QALYs, leading to an ICER of $152,229 per QALY gained in the TCAR arm Sensitivity analysis demonstrated that our model was most sensitive to probability of restenosis, costs of TCAR and costs of CEA. Probabilistic sensitivity analysis demonstrated TCAR would be considered cost effective 49% of iterations. CONCLUSIONS This study found that while five-year costs for TCAR were greater than CEA, TCAR afforded greater QALYs than CEA. TCAR became cost-effective at six-years follow-up.
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Affiliation(s)
- Christina Cui
- School of Medicine, University of California San Diego, La Jolla, Calif
| | - Ganesh Ramakrishnan
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, Calif
| | - James Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, Calif
| | - Mahmoud B Malas
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, Calif.
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Dorri S, Farahani MA, Mohammadebrahimi H, Shahraki S, Hakimi H. Reduction of the rate of hospitalization in patients with acute coronary syndrome: An action research. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:258-265. [PMID: 34277378 PMCID: PMC8262533 DOI: 10.4103/ijnmr.ijnmr_219_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/25/2020] [Accepted: 02/23/2021] [Indexed: 01/29/2023]
Abstract
Background: Readmission of patients with Acute Coronary Syndrome (ACS) causes many problems for them and their family. This study aimed to improve the quality of care provided to patients with ACS and discover solutions to reduce the rate of readmission among them. Materials and Method: This participatory action research study was done based on Streubert and Carpenter approach. This study included 45 participants (31 patients and 14 stakeholders) and carried out in a hospital affiliated to Isfahan University of Medical Sciences, Iran, from 2013 to 2014. Solutions with high and moderate feasibility, flexibility, and suitability were implemented in each cycle until reaching <15% readmission rate. Data were analyzed using SPSS (V.16) and running descriptive and inferential statistics. Results: In this study, several actions were performed in each cycle such as assigning a free and 24-h telephone line was patients to contact nurses and face-to-face patient's education. Second cycle actions included active participation of all nurses in the education of patients and involvement of families in patient care. By carrying out the first action cycle, the readmission rate reached 35%, which was not favorable. By completing the second action cycle, the readmission rate reached 12%, which was desirable and significantly lower than the first cycle. Conclusion: Discovering possible solutions with the participation of stakeholders in therapeutic settings that have feasibility, flexibility, and suitability can lead to improved care quality and reduced readmission rate in patients with ACS, especially if the families of the patients also participate in action cycles.
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Affiliation(s)
- Safoura Dorri
- Department of Medical Surgical Nursing, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mansoureh Ashghali Farahani
- Nursing Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran
| | - Hossein Mohammadebrahimi
- Department of Health in Disasters and Emergencies, School of Nursing, AJA University of Medical Sciences, Tehran, Iran
| | - Saied Shahraki
- Department of Health Services Management, Faculty of Health and Medical Engineering, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Hamideh Hakimi
- Nursing Care Research Center, Department of Pediatric Nursing, School of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran
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Thompson AD, Valley TS. Old Habits Die Hard: Do Stable Patients With Non-ST-Segment-Elevation Myocardial Infarction Need an Intensive Care Unit? Circ Cardiovasc Qual Outcomes 2021; 14:e007700. [PMID: 33757308 DOI: 10.1161/circoutcomes.120.007700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrea D Thompson
- Divison of Cardiovascular Medicine, Department of Internal Medicine (A.D.T.), University of Michigan, Ann Arbor
| | - Thomas S Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (T.S.V.), University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation (T.S.V.), University of Michigan, Ann Arbor.,Center for Bioethics and Social Sciences in Medicine (T.S.V.), University of Michigan, Ann Arbor
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3047] [Impact Index Per Article: 1015.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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31
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Patient outcomes in myeloproliferative neoplasm-related thrombosis: Insights from the National Inpatient Sample. Thromb Res 2020; 194:72-81. [DOI: 10.1016/j.thromres.2020.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 11/20/2022]
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32
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Aryan Z, Szanto A, Pantazi A, Reddi T, Rheinstein C, Powers W, Wilson E, Deo RC, Chowdhury S, Salz L, Dimmock D, Nahas S, Benson W, Kingsmore SF, MacRae CA, Vuzman D. Moving Genomics to Routine Care. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2020; 13:406-416. [DOI: 10.1161/circgen.120.002961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background:Whole-genome sequencing (WGS) costs are falling, yet, outside oncology, this information is seldom used in adult clinics. We piloted a rapid WGS (rWGS) workflow, focusing initially on estimating power for a feasibility study of introducing genome information into acute cardiovascular care.Methods:A prospective implementation study was conducted to test the feasibility and clinical utility of rWGS in acute cardiovascular care. rWGS was performed on 50 adult patients with acute cardiovascular events and cardiac arrest survivors, testing for primary and secondary disease-causing variants, cardiovascular-related pharmacogenomics, and carrier status for recessive diseases. The impact of returning rWGS results on short-term clinical care of participants was investigated. The utility of polygenic risk scores to stratify coronary artery disease was also assessed.Results:Pathogenic variants, typically secondary findings, were identified in 20% (95% CI, 11.7–34.3). About 60% (95% CI, 46.2–72.4) of participants were carriers for one or more recessive traits, most commonly inHFEandSERPINA1genes. Although 64% (95% CI, 50.1–75.9) of participants carried at least one pharmacogenetic variant of cardiovascular relevance, these were actionable in only 14% (95% CI, 7–26.2). Coronary artery disease prevalence among participants at the 95th percentile of polygenic risk score was 88.2% (95% CI, 71.8–95.7).Conclusions:We demonstrated the feasibility of rWGS integration into the inpatient management of adults with acute cardiovascular events. Our pilot identified pathogenic variants in one out of 5 acute vascular patients. Integrating rWGS in clinical care will progressively increase actionability.
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Affiliation(s)
- Zahra Aryan
- Cardiovascular Medicine Division, Department of Medicine (Z.A., A.S., C.R., W.P., E.W., R.C.D., C.A.M., D.V.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- One Brave Idea (Z.A., A.S., T.R., C.R., W.P., E.W., R.C.D., C.A.M., D.V.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Attila Szanto
- Cardiovascular Medicine Division, Department of Medicine (Z.A., A.S., C.R., W.P., E.W., R.C.D., C.A.M., D.V.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- One Brave Idea (Z.A., A.S., T.R., C.R., W.P., E.W., R.C.D., C.A.M., D.V.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | - Tejaswini Reddi
- One Brave Idea (Z.A., A.S., T.R., C.R., W.P., E.W., R.C.D., C.A.M., D.V.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Carolyn Rheinstein
- Cardiovascular Medicine Division, Department of Medicine (Z.A., A.S., C.R., W.P., E.W., R.C.D., C.A.M., D.V.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- One Brave Idea (Z.A., A.S., T.R., C.R., W.P., E.W., R.C.D., C.A.M., D.V.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Winslow Powers
- Cardiovascular Medicine Division, Department of Medicine (Z.A., A.S., C.R., W.P., E.W., R.C.D., C.A.M., D.V.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- One Brave Idea (Z.A., A.S., T.R., C.R., W.P., E.W., R.C.D., C.A.M., D.V.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA (W.P., C.A.M., D.V.)
| | - Evan Wilson
- One Brave Idea (Z.A., A.S., T.R., C.R., W.P., E.W., R.C.D., C.A.M., D.V.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Rahul C. Deo
- Cardiovascular Medicine Division, Department of Medicine (Z.A., A.S., C.R., W.P., E.W., R.C.D., C.A.M., D.V.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- One Brave Idea (Z.A., A.S., T.R., C.R., W.P., E.W., R.C.D., C.A.M., D.V.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Shimul Chowdhury
- Rady Children’s Institute for Genomic Medicine, San Diego, CA (S.C., L.S., D.D., S.N., W.B., S.F.K.)
| | - Lisa Salz
- Rady Children’s Institute for Genomic Medicine, San Diego, CA (S.C., L.S., D.D., S.N., W.B., S.F.K.)
| | - David Dimmock
- Rady Children’s Institute for Genomic Medicine, San Diego, CA (S.C., L.S., D.D., S.N., W.B., S.F.K.)
| | - Shareef Nahas
- Rady Children’s Institute for Genomic Medicine, San Diego, CA (S.C., L.S., D.D., S.N., W.B., S.F.K.)
| | - Wendy Benson
- Rady Children’s Institute for Genomic Medicine, San Diego, CA (S.C., L.S., D.D., S.N., W.B., S.F.K.)
| | - Stephen F. Kingsmore
- Rady Children’s Institute for Genomic Medicine, San Diego, CA (S.C., L.S., D.D., S.N., W.B., S.F.K.)
| | - Calum A. MacRae
- Cardiovascular Medicine Division, Department of Medicine (Z.A., A.S., C.R., W.P., E.W., R.C.D., C.A.M., D.V.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- One Brave Idea (Z.A., A.S., T.R., C.R., W.P., E.W., R.C.D., C.A.M., D.V.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA (W.P., C.A.M., D.V.)
| | - Dana Vuzman
- Cardiovascular Medicine Division, Department of Medicine (Z.A., A.S., C.R., W.P., E.W., R.C.D., C.A.M., D.V.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- One Brave Idea (Z.A., A.S., T.R., C.R., W.P., E.W., R.C.D., C.A.M., D.V.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Division of Genetics, Department of Medicine (D.V.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA (W.P., C.A.M., D.V.)
- Talerics Consulting LLC, Newton, MA (D.V.)
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Cowper PA, Knight JD, Davidson-Ray L, Peterson ED, Wang TY, Mark DB. Acute and 1-Year Hospitalization Costs for Acute Myocardial Infarction Treated With Percutaneous Coronary Intervention: Results From the TRANSLATE-ACS Registry. J Am Heart Assoc 2020; 8:e011322. [PMID: 30975005 PMCID: PMC6507213 DOI: 10.1161/jaha.118.011322] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Hospitalization for acute myocardial infarction (MI) in the United States is both common and expensive, but those features alone provide little insight into cost‐saving opportunities. Methods and Results To understand the cost drivers during hospitalization for acute MI and in the following year, we prospectively studied 11 969 patients with acute MI undergoing percutaneous coronary intervention at 233 US hospitals (2010–2013) from the TRANSLATE‐ACS (Treatment With ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) registry. Baseline costs were collected in a random subset (n=4619 patients, 54% ST‐segment–elevation MI [STEMI]), while follow‐up costs out to 1 year were collected for all patients. The mean index length of stay was 3.1 days (for both STEMI and non‐STEMI) and mean intensive care unit length of stay was 1.2 days (1.4 days for STEMI and 1.0 days for non‐STEMI). Index hospital costs averaged $18 931 ($19 327 for STEMI, $18 465 for non‐STEMI), with 45% catheterization laboratory–related and 20% attributable to postprocedure hospital stay. Patient factors, including severity of illness and extent of coronary disease, and hospital characteristics, including for profit status and geographic region, identified significant variations in cost. Intensive care was used for 53% of non‐STEMI and increased costs by $3282. Postdischarge 1‐year costs averaged $8037, and 48% of patients were rehospitalized (half within 2 months and 57% with a cardiovascular diagnosis). Conclusions While much of the cost of patients with acute MI treated with percutaneous coronary intervention is probably not modifiable by the care team, cost reductions are still possible through quality‐preserving practice efficiencies, such as need‐based use rather than routine use of intensive care unit for patients with stable non‐STEMI. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00097591. See Editorial Weintraub
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Affiliation(s)
- Patricia A Cowper
- 1 The Duke Clinical Research Institute Duke University Medical Center Durham NC
| | - J David Knight
- 1 The Duke Clinical Research Institute Duke University Medical Center Durham NC
| | - Linda Davidson-Ray
- 1 The Duke Clinical Research Institute Duke University Medical Center Durham NC
| | - Eric D Peterson
- 1 The Duke Clinical Research Institute Duke University Medical Center Durham NC
| | - Tracy Y Wang
- 1 The Duke Clinical Research Institute Duke University Medical Center Durham NC
| | - Daniel B Mark
- 1 The Duke Clinical Research Institute Duke University Medical Center Durham NC
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Gupta K, Chopra L, Salame A, Gharpure N, Prejean SP, von Mering G, Al Solaiman F, Eudailey K, Bajaj NS, Ahmed MI. Complete versus culprit-vessel only revascularization in STEMI: An updated meta-analysis of randomized control trials. IJC HEART & VASCULATURE 2020; 27:100481. [PMID: 32373708 PMCID: PMC7191581 DOI: 10.1016/j.ijcha.2020.100481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/21/2020] [Accepted: 02/02/2020] [Indexed: 11/21/2022]
Affiliation(s)
- Kartik Gupta
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lakshay Chopra
- All India Institute of Medical Sciences, New Delhi, India
| | - Ameen Salame
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nitin Gharpure
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shane P Prejean
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gregory von Mering
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Firas Al Solaiman
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kyle Eudailey
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Navkaranbir S Bajaj
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.,Section of Cardiology, Birmingham Veterans Affair Medical Center, Birmingham, AL, USA.,Division of Molecular Imaging and Therapeutics, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mustafa I Ahmed
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
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Berman AE, Miller DD. Quantifying the Economic Burden of Acute Myocardial Infarction: A Timely and Important Concept. Am J Med Sci 2020; 359:255-256. [PMID: 32359532 DOI: 10.1016/j.amjms.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Adam E Berman
- Departments of Medicine, Pediatrics and Population Health Sciences, Medical College of Georgia, Augusta, GA.
| | - D Douglas Miller
- Departments of Medicine, Radiology and Population Health Sciences, Medical College of Georgia, Augusta, GA
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Asad ZUA, Khan SU, Amritphale A, Shroff A, Lata K, Seto AH, Khan MS, Rao SV, Abu-Fadel M. Early vs Late Discharge in Low-Risk ST-Elevation Myocardial Infarction Patients Treated With Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1360-1368. [PMID: 32473910 DOI: 10.1016/j.carrev.2020.04.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND For low-risk patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) the recommended optimal discharge timing is inconsistent in guidelines. The European Society of Cardiology guidelines recommend early discharge within 48-72 h, while the American College of Cardiology guidelines do not recommend a specific discharge strategy. In this systematic review and meta-analysis we compared outcomes with early discharge (≤3 days) versus late discharge (>3 days). METHODS Randomized controlled trials (RCTs) and observational studies were selected after searching MEDLINE and EMBASE database. Meta-analysis was stratified according to study design. Outcomes were reported as random effects risk ratios (RR) with 95% confidence intervals. RESULTS Seven RCTs comprising 1780 patients and 4 observational studies comprising 39,288 patients were selected. The RCT-restricted analysis did not demonstrate significant differences in terms of all-cause mortality (RR, 0.97 [0.23-4.05]) and major adverse cardiac events (MACE) (RR, 0.84 [0.56-1.26]). Conversely, observational study restricted analysis showed that early vs late discharge strategy was associated with a reduction in all-cause mortality (RR, 0.40 [0.23-0.71]) and MACE (RR, 0.45 [0.26-0.78]). There were no significant differences in hospital readmissions between early vs late discharge in both RCT or observational study analyses. CONCLUSIONS Early discharge strategy in appropriately selected low-risk patients with STEMI undergoing PCI is safe and it has the potential to improve cost of care.
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Affiliation(s)
- Zain Ul Abideen Asad
- Department of Medicine, Section of Cardiovascular Disease, University of Oklahoma Health Sciences Center, Oklahoma City, United States of America.
| | - Safi U Khan
- Department of Internal Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Amod Amritphale
- Department of Medicine, Section of Cardiovascular Disease, University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - Adhir Shroff
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Kusum Lata
- Sutter Tracy Community Hospital, Sutter Medical Network, Tracy, CA, United States of America
| | - Arnold H Seto
- Department of Medicine, Long Beach Veterans Affairs Healthcare System, Long Beach, CA, United States of America
| | - Muhammad Shahzeb Khan
- Department of Internal Medicine, John H Stroger, Jr Hospital of Cook County, Chicago, United States of America
| | - Sunil V Rao
- Division of Cardiology, Duke Clinical Research Institute, Durham, NC, United States of America
| | - Mazen Abu-Fadel
- Department of Medicine, Section of Cardiovascular Disease, University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
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Yang KT, Yin CH, Hung YM, Huang SJ, Lee CC, Kuo TJ. Continuity of Care Is Associated with Medical Costs and Inpatient Days in Children with Cerebral Palsy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082913. [PMID: 32340141 PMCID: PMC7215569 DOI: 10.3390/ijerph17082913] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 01/05/2023]
Abstract
Background: Children with cerebral palsy (CP) place a considerable burden on medical costs and add to an increased number of inpatient days in Taiwan. Continuity of care (COC) has not been investigated in this population thus far. Materials and Methods: We designed a retrospective population-based cohort study using Taiwan’s National Health Insurance Research Database. Patients aged 0 to 18 years with CP catastrophic illness certificates were enrolled. We investigated the association of COC index (COCI) with medical costs and inpatient days. We also investigated the possible clinical characteristics affecting the outcome. Results: Over five years, children with CP with low COCI levels had higher medical costs and more inpatient days than did those with high COCI levels. Younger age at CP diagnosis, more inpatient visits one year before obtaining a catastrophic illness certificate, pneumonia, and nasogastric tube use increased medical expenses and length of hospital stay. Conclusions: Improving COC reduces medical costs and the number of inpatient days in children with CP. Certain characteristics also influence these outcomes.
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Affiliation(s)
- Kuang-Tsu Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Chun-Hao Yin
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Yao-Min Hung
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
- Yuh-Ing Junior College of Health Care and Management, Kaohsiung 80776, Taiwan
| | - Shih-Ju Huang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Ching-Chih Lee
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei 11221, Taiwan
| | - Tsu-Jen Kuo
- Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
- Department of Dental Technology, Shu-Zen Junior College of Medicine and Management, Kaohsiung 82144, Taiwan
- Correspondence: ; Tel.: +886-7-346-8214; Fax: +886-7-346-8392
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Abstract
See Article Cowper et al
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