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Jamshidi A, Daroudi R, Aas E, Khalili D. A cost-effectiveness analysis of risk-based intervention for prevention of cardiovascular diseases in IraPEN program: A modeling study. Front Public Health 2023; 11:1075277. [PMID: 36908421 PMCID: PMC9999709 DOI: 10.3389/fpubh.2023.1075277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/23/2023] [Indexed: 03/14/2023] Open
Abstract
Background IraPEN, a program developed in Iran based on the World Health Organization (WHO) package of essential noncommunicable (PEN) disease interventions for primary healthcare, was launched in 2015. Preventive interventions for cardiovascular diseases (CVDs) are based on the level of risk calculated using the WHO CVD risk chart. Objective The main objective of this study was to measure the potential cost-effectiveness (CE) of IraPEN preventive actions for CVD in comparison with the status quo. Methods A CE analysis from a healthcare perspective was conducted. Markov models were employed for individuals with and without diabetes separately. Based on the WHO CVD risk chart, four index cohorts were constructed as low (<10%), moderate (10%-19%), high (20%-29%), and very high risk (≥30%). Life years (LY) gained and quality-adjusted life years (QALY) were used as the outcome measures. Results The intervention yields an incremental cost-effectiveness ratio (ICER) of $804, $551, and -$44 per QALY for moderate, high, and very high CVD risk in groups without diabetes, respectively. These groups gained 0.69, 0.96, and 1.45 LY, respectively, from the intervention. The results demonstrated an ICER of $711, $630, -$42, and -$71 for low, moderate, high, and very high-risk groups with diabetes, respectively, while they gained 0.46, 1.2, 2.04, and 2.29 years from the intervention. Conclusion The IraPEN program was highly cost-effective for all CVD risk groups in the individuals without diabetes except the low-risk group. The intervention was cost-effective for all patients with diabetes regardless of their CVD risk. The results demonstrated that the IraPEN program can likely provide substantial health benefits to Iranian individuals and cost savings to the national healthcare provider.
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Affiliation(s)
- Amirparviz Jamshidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Rajabali Daroudi
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Eline Aas
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Decker JA, Varga-Szemes A, Schoepf UJ, Emrich T, Schwarz F, Kroencke TJ, Scheurig-Muenkler C. In-patient care trends in peripheral artery disease in the German healthcare system over the past decade. Eur Radiol 2021; 32:1697-1708. [PMID: 34647176 DOI: 10.1007/s00330-021-08285-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/04/2021] [Accepted: 08/19/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To analyze trends of in-hospital treatment of patients admitted due to peripheral artery disease (PAD) from 2009 to 2018 with special focus on comorbidities, revascularization procedures, resulting costs, and outcome. METHODS Using data from the research data center of the German Federal Statistical Office, we included all hospitalizations due to PAD Fontaine stage IIb or higher from 2009 to 2018. To analyze comorbidities, Elixhauser diagnostic groups and linear van Walraven score (vWS) were assessed. RESULTS A total of 1.8 million hospitalizations resulting in €10.3 billion in reimbursement costs were included. From 2009 to 2018, the absolute number of hospitalizations due to PAD increased by 13.3% (163,547 to 185,352). The average cost per hospitalization increased by 20.8% from €5,261 to €6,356. The overall in-hospital mortality decreased from 3.1 to 2.6%. Median vWS of all PAD cases increased by 3 points (2 to 5). The number of percutaneous transluminal angioplasties (PTA) increased by 43.9% while some surgical procedures such as bypasses and embolectomies decreased by 30.8% and 6.8%, respectively. Many revascularization procedures showed a disproportionate increase of those performed in vessels below the knee for example in PTA (+ 68.5%) or in endarterectomies (+ 38.8%). CONCLUSIONS This decade-long nationwide analysis shows a rising number of hospitalizations due to PAD with more comorbid patients resulting in increasing reimbursement costs. Interventions are shifting from surgical to endovascular approaches with a notable trend towards interventions in smaller vessels below the knee. KEY POINTS • The number of hospitalizations due to peripheral artery disease is rising and it is associated with increasing reimbursement costs. • Admitted patients are older and show an increasing number of comorbidities while overall in-hospital mortality is decreasing. • Revascularization procedures are shifting from surgical to endovascular approaches and show a trend towards intervention in smaller vessels below the knee. • Major amputations are decreasing while the number of minor amputations is increasing.
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Affiliation(s)
- Josua A Decker
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany.,Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Florian Schwarz
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Thomas J Kroencke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
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Artamonova GV, Maksimov SA, Tsygankova DP, Bazdyrev ED, Indukaeva EV, Mulerova TA, Shapovalova EB, Agienko AS, Nakhratova OV, Barbarash OL. Changes in Cardiovascular Risk Factors in Residents of the Siberian Region (According to Epidemiological Studies). RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-06-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To analyze prevalence of cardiovascular risk factors in the Kemerovo region based on the results of epidemiological studies (2013 and 2016).Material and methods. The study was based on two large epidemiological studies of the Kemerovo region: on 2013, «The epidemiology of cardiovascular diseases and their risk factors in the Russian Federation» and on 2016, «The prospective study of urban and rural epidemiology: study of the influence of social factors on chronic non-infectious diseases in low, middle and high income countries». In the study we analyzed cardiovascular risk factors using identical questionnaires, functional, anthropometric, biochemical means and measured on identical scales. As a result, we analyzed the prevalence of smoking, diabetes mellitus, overweight and obesity, abdominal obesity, hypercholesterolemia and hypertriglyceridemia, high levels of low-density lipoprotein (LDL).Results. Univariate analysis indicates that in the sample of 2016, compared to the sample of 2013, the prevalence of smoking is statistically significantly lower, as well as the proportion of participants with high cholesterol levels, but not taking lipid-lowering drugs. In contrast, the prevalence of diabetes, hypercholesterolemia and hypertriglyceridemia is higher. In women, the frequency of abdominal obesity on 2016 is lower than on 2013: at 35-44 age group odds ratio (OR) =0.67 with 95% confidence interval (CI) 0.44-1.03, at 45-54 age group OR =0.47 with 95% CI 0.31-0.72, 55-65 age group OR =0.49 with 95% CI 0.30-0.79. A high incidence of diabetes, hypercholesterolemia and hypertriglyceridemia is characteristic mainly of older women (55-65 age group): accordingly, OR =1.96 with 95% CI 1.19-3.22, OR =1.42 with 95% CI 1,02-1.97, OR =1.51 at 95% CI 1.08-2.12. In the 45-54 age group of men, they smoked statistically significantly less often on 2016 compared to 2013, OR =0.59 with 95% CI 0.36-0.96. The prevalence of overweight and obesity in both samples is the same: for women, the OR for overweight in different age groups is within 0.74-0.87, for men - within 0.95-1.78; for obesity OR in women is from 0.70 to 0.79, in men - from 1.03 to 1.34.Conclusion. A significant advantage of the study is the analysis of changes in prevalence in age and gender groups, which showed significant differences in the dynamics of men and women in different age categories for a number of risk factors. Analysis of the dynamics of the prevalence of cardiovascular risk factors makes it possible to assess the effectiveness of state and regional policies in the field of health protection and, first of all, "risk groups” that require closer attention, development and implementation of targeted health-saving technologies.
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Affiliation(s)
- G. V. Artamonova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - S. A. Maksimov
- National Medical Research Center for Therapy and Preventive Medicine
| | - D. P. Tsygankova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - E. D. Bazdyrev
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - E. V. Indukaeva
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - T. A. Mulerova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | | | - A. S. Agienko
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - O. V. Nakhratova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - O. L. Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
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Sadeghi M, Golshahi J, Talaei M, Sheikhbahaei E, Ghodjani E, Mansouri M, Mansouri P, Sarrafzadegan N, Roohafza H. 15-Year lipid profile effects on cardiovascular events adjusted for cardiovascular risk factors: a cohort study from Middle-East. Acta Cardiol 2021; 76:194-199. [PMID: 32019473 DOI: 10.1080/00015385.2020.1717096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Dyslipidaemia is a risk factor for cardiovascular disease (CVD); however, there are only a few long-term cohort studies. The aim of this unique study is to evaluate the effects of several lipid markers on cardiovascular outcomes during a 15-year follow-up from the Isfahan cohort study (ICS). METHODS This ongoing cohort study was started in 2001 in three cities of Iran. The study population includes 5432 individuals older than 35 years and with Iranian citizenship. All of the patients were evaluated every 2 years by telephone and a full medical examination with blood sampling was conducted every 5 years. The data were recorded in our checklists. Dyslipidaemia was defined according to the ATPIII criteria. Our endpoints in this study were any cardiovascular events such as stroke, sudden cardiac death, unstable angina or myocardial infarction (MI). RESULTS cardiovascular events were significantly higher in males, older people, diabetics, smokers, patients with higher BMIs, higher blood pressure, dyslipidaemia and less educational level, physical activity index and global dietary index. Our adjusted multivariable analysis (for cardiovascular risk factors and demographic factors) revealed that dyslipidaemia could increase the risk of 15-year cardiovascular events by 1.59 times (HR = 1.59 [1.23-2.06], p value < .001) adjusted for demographic factors and baseline cardiovascular risk factors. CONCLUSIONS Dyslipidaemia, as an independent risk factor, was associated with future cardiovascular events. In this regard, serum lipid screening can help to decrease the risk of long-term cardiovascular events.
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Affiliation(s)
- Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jafar Golshahi
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Talaei
- Institute of Population Health Sciences, Barts and the London School of Medicine, Queen Mary University of London, UK
| | - Erfan Sheikhbahaei
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Science, Isfahan, Iran
| | - Erfan Ghodjani
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadhadi Mansouri
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pejman Mansouri
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Goudarzian AH, Sharif Nia H, Harry KM, Jannati Y. Assessment of the Psychometric Properties of the Persian Version of the Cardiac Self-Blame Attribution (CSBA-P) Scale in Patients With Cardiovascular Disease. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:792-811. [PMID: 32903153 DOI: 10.1177/0030222820947224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
According to the studies done in Iran, there has been no study investigating self-blame attributions in patients with cardiovascular disease. Moreover, there has been no standard scale for assessing self-blame attributions available in Persian. Hence, this study was conducted to determine the psychometric properties of the Persian version of Cardiac Self-Blame Attribution (CSBA-P) Scale in patients with cardiovascular disease. In this 2019 methodological study, 400 patients with cardiovascular disease completed the Persian version of the Cardiac Self-Blame Attribution scale. We evaluated the face, content, and construct validity (both exploratory and confirmatory) of the measure. The results of the confirmatory and exploratory factor analysis extracted a separate factor explained 56.249% of the variance. One factor fit model was confirmed according to standard measures such as RMSEA = 0.074, CMIN/DF = 2.454. The reliability of the scale was calculated and confirmed with a Cronbach coefficient of 0.938, construct reliability of 0.938, and ICC of 0.895. The Persian version of the Cardiac Self-Blame Attribution scale (CSBA-P) yielded acceptable validity and reliability. Thus, this scale can be used in future research to assess self-blame attributions among cardiac populations who speak Persian.
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Affiliation(s)
- Amir Hossein Goudarzian
- Psychiatric Nursing, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamid Sharif Nia
- School of Nursing and Midwifery Amol, Mazandaran University of Medical Sciences, Sari, Iran
| | - Kadie M Harry
- Saint Luke's Cancer Institute, Kansas City, Missouri, United States
| | - Yadollah Jannati
- Psychiatry and Behavioral Sciences Research Center, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
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Shiyovich A, Shlomo N, Cohen T, Iakobishvili Z, Kornowski R, Eisen A. Temporal trends of patients with acute coronary syndrome and multi-vessel coronary artery disease - from the ACSIS registry. Int J Cardiol 2020; 304:8-13. [DOI: 10.1016/j.ijcard.2020.01.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/13/2020] [Accepted: 01/20/2020] [Indexed: 12/16/2022]
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Sadeghipour P, Bakhshandeh H, Maleki M, Noohi F, Boudagh S, Khalili Y, Alizadehasl A, Naderi N, Mohebbi B, Moghaddam Y, Haghjoo M, Arabian M, Alemzadeh-Ansari M, Baay M, Pouraliakbar H, Ghaemmaghami Z, Khaleghparast S, Ghadrdoost B, Pasha H, Hosseini Z, Golpira R, Mahdieh N, Nikpajouh A. Heart Assessment and Monitoring in Rajaie Hospital (HAMRAH): A population-based cohort study. Res Cardiovasc Med 2020. [DOI: 10.4103/rcm.rcm_17_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Plakht Y, Abu Eid A, Gilutz H, Shiyovich A. Trends of Cardiovascular Risk Factors in Patients With Acute Myocardial Infarction: Soroka Acute Myocardial Infarction II (SAMI II) Project. Angiology 2018; 70:530-538. [PMID: 30518230 DOI: 10.1177/0003319718816479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONCLUSIONS The last decade, patients with AMI became older with increased burden of CVRFs. Framingham risk score increased among patients with NSTEMI and decreased in patients with STEMI. These trends impact on risk stratification and secondary prevention programs.
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Affiliation(s)
- Ygal Plakht
- 1 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,2 Soroka University Medical Center, Beer-Sheva, Israel
| | - Abeer Abu Eid
- 1 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Harel Gilutz
- 1 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,2 Soroka University Medical Center, Beer-Sheva, Israel
| | - Arthur Shiyovich
- 3 Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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