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Oude Wolcherink MJ, Behr CM, Pouwels XGLV, Doggen CJM, Koffijberg H. Health Economic Research Assessing the Value of Early Detection of Cardiovascular Disease: A Systematic Review. PHARMACOECONOMICS 2023; 41:1183-1203. [PMID: 37328633 PMCID: PMC10492754 DOI: 10.1007/s40273-023-01287-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) is the most prominent cause of death worldwide and has a major impact on healthcare budgets. While early detection strategies may reduce the overall CVD burden through earlier treatment, it is unclear which strategies are (most) efficient. AIM This systematic review reports on the cost effectiveness of recent early detection strategies for CVD in adult populations at risk. METHODS PubMed and Scopus were searched to identify scientific articles published between January 2016 and May 2022. The first reviewer screened all articles, a second reviewer independently assessed a random 10% sample of the articles for validation. Discrepancies were solved through discussion, involving a third reviewer if necessary. All costs were converted to 2021 euros. Reporting quality of all studies was assessed using the CHEERS 2022 checklist. RESULTS In total, 49 out of 5552 articles were included for data extraction and assessment of reporting quality, reporting on 48 unique early detection strategies. Early detection of atrial fibrillation in asymptomatic patients was most frequently studied (n = 15) followed by abdominal aortic aneurysm (n = 8), hypertension (n = 7) and predicted 10-year CVD risk (n = 5). Overall, 43 strategies (87.8%) were reported as cost effective and 11 (22.5%) CVD-related strategies reported cost reductions. Reporting quality ranged between 25 and 86%. CONCLUSIONS Current evidence suggests that early CVD detection strategies are predominantly cost effective and may reduce CVD-related costs compared with no early detection. However, the lack of standardisation complicates the comparison of cost-effectiveness outcomes between studies. Real-world cost effectiveness of early CVD detection strategies will depend on the target country and local context. REGISTRATION OF SYSTEMATIC REVIEW CRD42022321585 in International Prospective Registry of Ongoing Systematic Reviews (PROSPERO) submitted at 10 May 2022.
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Affiliation(s)
- Martijn J Oude Wolcherink
- Health Technology and Services Research, Techmed Centre, University of Twente, Enschede, The Netherlands
| | - Carina M Behr
- Health Technology and Services Research, Techmed Centre, University of Twente, Enschede, The Netherlands
| | - Xavier G L V Pouwels
- Health Technology and Services Research, Techmed Centre, University of Twente, Enschede, The Netherlands
| | - Carine J M Doggen
- Health Technology and Services Research, Techmed Centre, University of Twente, Enschede, The Netherlands
| | - Hendrik Koffijberg
- Health Technology and Services Research, Techmed Centre, University of Twente, Enschede, The Netherlands.
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Li W, Kim CS, Howell EA, Janevic T, Liu B, Shi L, Li Y. Economic Evaluation of Prenatal and Postpartum Care in Women With Gestational Diabetes and Hypertensive Disorders of Pregnancy: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:2062-2080. [PMID: 35989155 PMCID: PMC9669139 DOI: 10.1016/j.jval.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to summarize evidence on the economic outcomes of prenatal and postpartum interventions for the management of gestational diabetes mellitus and hypertensive disorders of pregnancy (HDP), assess the quality of each study, and identify research gaps that may inform future research. METHODS Electronic databases including PubMed/MEDLINE, Embase, the Cochrane Library, and Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to October 1, 2021. Selected studies were included in narrative synthesis and extracted data were presented in narrative and tabular forms. The quality of each study was assessed using the Consolidated Health Economic Evaluation Reporting Standards and Consensus on Health Economic Criteria list. RESULTS Among the 22 studies identified through the systematic review, 19 reported favorable cost-effectiveness of the intervention. For prenatal management of HDP, home blood pressure monitoring was found to be cost-effective compared with in-person visits in improving maternal and neonatal outcomes. For postpartum care, regular screening for hypertension or metabolic syndrome followed by subsequent treatment was found to be cost-effective compared with no screening in women with a history of gestational diabetes mellitus or HDP. CONCLUSIONS Existing economic evaluation studies showed that prenatal home blood pressure monitoring and postpartum screening for hypertension or metabolic syndrome were cost-effective. Nevertheless, limitations in the approach of the current economic evaluations may dampen the quality of the evidence and warrant further investigation.
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Affiliation(s)
- Weixin Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; The Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chi-Son Kim
- Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, CT, USA
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Teresa Janevic
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Blavatnik Family Women's Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lizheng Shi
- Department of Global Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Blavatnik Family Women's Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Teoule J, Woll C, Sütterlin M, Filsinger B. Versorgungsrealität von Frauen nach hypertensiver
Schwangerschaftserkrankung – eine monozentrische fragebogenbasierte
Analyse. Z Geburtshilfe Neonatol 2022; 227:127-133. [PMID: 36302547 DOI: 10.1055/a-1956-4358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Zusammenfassung
Einleitung Frauen nach einer hypertensiven Schwangerschaftserkrankung wird
aufgrund ihres signifikant erhöhten kardiovaskulären Risikos zu
Screeninguntersuchungen und primärer Prävention geraten. Diese
Studie soll einen Beitrag zur Ermittlung der aktuellen Nachsorgepraxis leisten
und aufzeigen, wie viele Frauen an den empfohlenen Nachsorgeuntersuchungen mit
Beratung zur Reduktion von Risikofaktoren teilnehmen.
Material und Methoden Monozentrische Patientinnenbefragung von 113 Frauen,
welche im Zeitraum von 2014 bis 2019 von einer hypertensiven
Schwangerschaftserkrankung betroffen waren. Es erfolgte eine deskriptive
statistische Auswertung.
Ergebnisse Eine Nachsorgeuntersuchung erfolgte bei 54% der Frauen.
Es wurden 47% der Patientinnen im persönlichen Gespräch
über ihre Erkrankung informiert und auf mögliche langfristige
gesundheitliche Konsequenzen hingewiesen. Von 67 übergewichtigen Frauen
(BMI≥25 kg/m2) erhielten 23% eine
Empfehlung zur Steigerung der körperlichen Aktivität und
13% wurde zur Gewichtsreduktion geraten. Es stellten sich signifikant
mehr Frauen mit höherer Krankheitslast (BMI, p=0,027;
arterieller Hypertonus, p=0,016) und gravierender Ausprägung der
Erkrankung (Eklampsie, Aufenthalt auf einer Intensivstation, jeweils
p=0,049) zu weiteren Untersuchungen vor.
Schlussfolgerung Die vorliegenden Ergebnisse legen nahe, dass die
Maßnahmen zur Prävention und Früherkennung von
kardiovaskulären Erkrankungen in unserem Patientinnenkollektiv nicht
ausgeschöpft wurden. Unabhängig des Ausprägungsgrades
der Erkrankung sollten alle Frauen eine Empfehlung zur Teilnahme an
Nachsorgeuntersuchung erhalten.
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Affiliation(s)
- Julia Teoule
- Frauenklinik, Ruprecht-Karls-Universität Heidelberg
Medizinische Fakultät Mannheim, Mannheim, Germany
| | - Christian Woll
- Psychologie, Ludwigs-Maximilians-Universität München,
Lehr- und Forschungseinheit Klinische Psychologie des Kindes- und Jugendalters,
München, Germany
| | - Marc Sütterlin
- Frauenklinik, Ruprecht-Karls-Universität Heidelberg
Medizinische Fakultät Mannheim, Mannheim, Germany
| | - Barbara Filsinger
- Frauenklinik, Ruprecht-Karls-Universität Heidelberg
Medizinische Fakultät Mannheim, Mannheim, Germany
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Shi P, Zhao L, Yu S, Zhou J, Li J, Zhang N, Xing B, Cui X, Yang S. Differences in epidemiology of patients with preeclampsia between China and the US (Review). Exp Ther Med 2021; 22:1012. [PMID: 34345294 PMCID: PMC8311229 DOI: 10.3892/etm.2021.10435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 03/11/2021] [Indexed: 12/14/2022] Open
Abstract
Preeclampsia (PE) is a complex complication that occurs during pregnancy. Studies indicated that morbidity from PE exhibits marked variations among geographical areas. Disparities in the incidence of PE between China and the US may be due to differences in ethnicity and genetic susceptibility, maternal age, sexual culture, body mass index, diet, exercise, multiple pregnancies and educational background. These epidemiological differences may give rise to differences between the two countries in terms of diagnostic and therapeutic criteria for PE. PE may be largely attributed to susceptibility genes and lifestyles, such as diet, body mass index and cultural norms regarding sexual relationships. The epidemiologic differences of patients with PE between the two countries indicated that appropriate prevention plans for PE require to be developed according to local conditions.
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Affiliation(s)
- Ping Shi
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Lei Zhao
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Sha Yu
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Jun Zhou
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Jing Li
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Ning Zhang
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Baoxiang Xing
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Xuena Cui
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Shengmei Yang
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
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Palmrich P, Binder C, Zeisler H, Kroyer B, Pateisky P, Binder J. Awareness of obstetricians for long-term risks in women with a history of preeclampsia or HELLP syndrome. Arch Gynecol Obstet 2021; 305:581-587. [PMID: 34406457 PMCID: PMC8918160 DOI: 10.1007/s00404-021-06181-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/04/2021] [Indexed: 12/01/2022]
Abstract
Purpose Hypertensive disorders of pregnancy are still a leading cause of maternal and neonatal morbidity and mortality worldwide. Women with a history of preeclampsia have an increased risk for future cardiovascular and cerebrovascular disease, renal disease as well as diabetes mellitus. There is little knowledge on postpartum risk management. The aim of this study was to assess follow-up care for patients after pre-eclampsia or HELLP syndrome. Methods This questionnaire-based cross-sectional study aimed to evaluate the current recommendations of obstetricians in Austria regarding follow-up care, long-term risk counselling and risk of recurrence in future pregnancies after preeclampsia or HELLP syndrome. Data were collected using a survey, based on recommendations given by three substantial guidelines on hypertensive disorders of pregnancy, which was distributed via e-mail to 69 public obstetric departments in Austria. Each obstetric department was required to answer one questionnaire per local protocol. Results Our results revealed that of the 48 participating hospitals most obstetricians are aware of the importance of follow-up care for women after a pregnancy complicated by preeclampsia. Our data show that most physicians counselled patients about the future cardiovascular health risks associated with preeclampsia or HELLP syndrome (79.2%). Most obstetricians recommended lifestyle modification (77.1%) and continued blood pressure measurements (97.9%). All centers stated to counsel about the risk of recurrence (100%). However, counselling regarding follow-up care to exclude kidney damage (37.5%) and underlying diseases like thrombophilia (39.6%) were less prioritized. Conclusions We were able to show that counselling concerning the risk of long-term cardiovascular disease and risk of recurrence after a pregnancy complicated by preeclampsia or HELLP syndrome has been established in obstetric departments in public hospitals. Regarding the evaluation of underlying chronic diseases such as thrombophilia or renal disease, as well as counselling on the future risk of renal disease is still improvable according to our data. Further evaluation of follow-up care after hypertensive disorders of pregnancy in the outpatient and private sector and implementation of structured guidelines for follow-up, as well as screening for cardiovascular disease are necessary to ensure adequate risk management and to provide opportunities for prevention. Supplementary Information The online version contains supplementary material available at 10.1007/s00404-021-06181-w.
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Affiliation(s)
- Pilar Palmrich
- Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria.
| | - Carina Binder
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Harald Zeisler
- Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Bettina Kroyer
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Petra Pateisky
- Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Julia Binder
- Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
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Pittara T, Vyrides A, Lamnisos D, Giannakou K. Pre-eclampsia and long-term health outcomes for mother and infant: an umbrella review. BJOG 2021; 128:1421-1430. [PMID: 33638891 DOI: 10.1111/1471-0528.16683] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/23/2020] [Accepted: 02/09/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Pre-eclampsia is a pregnancy-associated condition with complex disease mechanisms and a risk factor for various long-term health outcomes for the mother and infant. OBJECTIVE To summarise evidence on the association of pre-eclampsia with long-term health outcomes arising in women and/or infants. SEARCH STRATEGY PubMed, EMBASE, Scopus and ISI Web of Science were searched from inception to July 2020. SELECTION CRITERIA Systematic reviews and meta-analyses examining associations between pre-eclampsia and long-term health outcomes in women and their infants. DATA COLLECTION AND ANALYSIS Data were extracted by two independent reviewers. We re-estimated the summary effect size by random-effects and fixed-effects models, the 95% confidence interval, the 95% prediction interval, the between-study heterogeneity, any evidence of small-study effects and excess significance bias. RESULTS Twenty-one articles were included (90 associations). Seventy-nine associations had nominally statistically significant findings (P < 0.05). Sixty-five associations had large or very large heterogeneity. Evidence for small-study effects and excess significance bias was found in seven and two associations, respectively. Nine associations: cerebrovascular disease (cohort studies), cerebrovascular disease (overall), cardiac disease (cohort studies), dyslipidaemia (all studies), risk of death (late-onset pre-eclampsia), fatal and non-fatal ischaemic heart disease, cardiovascular mortality (cohort studies), any diabetes or use of diabetic medication (unadjusted), and attention deficit/hyperactivity disorder (ADHD) (adjusted) were supported with robust evidence. CONCLUSION Many of the meta-analyses in this research field have caveats casting doubts on their validity. Current evidence suggests an increased risk for women to develop cardiovascular-related diseases, diabetes and dyslipidaemia after pre-eclampsia, while offspring exposed to pre-eclampsia are at higher risk for ADHD. TWEETABLE ABSTRACT Cardiovascular and cerebrovascular diseases were supported with convincing evidence for long-term health outcomes after pre-eclampsia.
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Affiliation(s)
- T Pittara
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - A Vyrides
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - D Lamnisos
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - K Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
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Disparities in Cardiovascular Care and Outcomes for Women From Racial/Ethnic Minority Backgrounds. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020; 22:75. [PMID: 33223802 PMCID: PMC7669491 DOI: 10.1007/s11936-020-00869-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 12/14/2022]
Abstract
Purpose of review Racial, ethnic, and gender disparities in cardiovascular care are well-documented. This review aims to highlight the disparities and impact on a group particularly vulnerable to disparities, women from racial/ethnic minority backgrounds. Recent findings Women from racial/ethnic minority backgrounds remain underrepresented in major cardiovascular trials, limiting the generalizability of cardiovascular research to this population. Certain cardiovascular risk factors are more prevalent in women from racial/ethnic minority backgrounds, including traditional risk factors such as hypertension, obesity, and diabetes. Female-specific risk factors including gestational diabetes and preeclampsia as well as non-traditional psychosocial risk factors like depressive and anxiety disorders, increased child care, and familial and home care responsibility have been shown to increase risk for cardiovascular disease events in women more so than in men, and disproportionately affect women from racial/ethnic minority backgrounds. Despite this, minimal interventions to address differential risk have been proposed. Furthermore, disparities in treatment and outcomes that disadvantage minority women persist. The limited improvement in outcomes over time, especially among non-Hispanic Black women, is an area that requires further research and active interventions. Summary Understanding the lack of representation in cardiovascular trials, differential cardiovascular risk, and disparities in treatment and outcomes among women from racial/ethnic minority backgrounds highlights opportunities for improving cardiovascular care among this particularly vulnerable population.
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Oikonomou P, Tsonis O, Paxinos A, Gkrozou F, Korantzopoulos P, Paschopoulos M. Preeclampsia and long-term coronary artery disease: How to minimize the odds? Eur J Obstet Gynecol Reprod Biol 2020; 255:253-258. [PMID: 33153771 DOI: 10.1016/j.ejogrb.2020.10.061] [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: 04/05/2020] [Revised: 10/02/2020] [Accepted: 10/23/2020] [Indexed: 11/25/2022]
Abstract
Preeclampsia (PE) is a hypertensive disorder of pregnancy that can cause detrimental obstetric outcomes if not managed properly. Current evidence demonstrates higher risk for long-term cardiovascular disease in preeclamptic women. Even in uncomplicated pregnancies, the heart work overload often reveals subtle cardiac defects or abnormalities, which otherwise remain undiagnosed in women without a history of pregnancy. Pathophysiologic patterns occurring in PE patients resemble biochemical responses observed in cases of cardiovascular disease. It has been estimated that women with an obstetric history of PE are more likely to develop coronary artery disease in the long run. Currently, additionally to whether any approach could actually contribute to minimizing mortality and morbidity among these affected populations, there is no consensus regarding management for these patients. In this review we summarized the current scientific evidence regarding the correlation between PE and long-term coronary artery disease. Based on this knowledge, we propose postpartum and lifetime management for these high-risk patients in order to minimize morbidity and mortality within this population.
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Affiliation(s)
- P Oikonomou
- Department of Cardiology, General Hospital of Preveza, Greece
| | - O Tsonis
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Greece.
| | - A Paxinos
- Private Urology Clinic, Preveza, Greece
| | - F Gkrozou
- Department of Obstetrics and Gynaecology, University Hospitals of Birmingham, UK
| | - P Korantzopoulos
- Department of Cardiology, University Hospital of Ioannina, Greece
| | - M Paschopoulos
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Greece
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Glisic M, Muka T, Franco OH. Cardiovascular screening and prevention strategies in women with history of preeclampsia: One size does not fit all. Eur J Prev Cardiol 2020; 27:1386-1388. [PMID: 32131625 DOI: 10.1177/2047487320908977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Marija Glisic
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland.,Swiss Paraplegic Research, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
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