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Migliaccio-Walle K, Elsea D, Gupta A, Sarnes E, Griffith K, Pandey R, Gillard K. Treatment intensification with bempedoic acid to achieve LDL-C goal in patients with ASCVD: A simulation model using a real-world patient cohort in the US. ATHEROSCLEROSIS PLUS 2024; 55:98-105. [PMID: 38571880 PMCID: PMC10987878 DOI: 10.1016/j.athplu.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 04/05/2024]
Abstract
Background and aims Guidelines recommend that high-risk patients with atherosclerotic cardiovascular disease (ASCVD) be treated with maximally tolerated statins to lower low-density lipoprotein cholesterol (LDL-C) levels and reduce the risk of major adverse cardiovascular events. In patients whose LDL-C remains elevated, non-statin adjunct therapies, including ezetimibe (EZE), bempedoic acid (BA), and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are recommended. Methods The impact of BA and EZE in a fixed-dose combination (FDC) on LDL-C goal attainment was evaluated using a simulation model developed for a United States cohort of high-risk adults with ASCVD. Treatment was simulated for 73,056 patients not at goal (LDL-C >70 mg/dL), comparing BA + EZE (FDC), EZE only, and no oral adjunct therapy (NOAT). The addition of PCSK9 inibitors was assumed after 1 year in patients not at LDL-C goal. Treatment efficacy was estimated from clinical trials. Patient-level outcomes were predicted over a 10-year horizon accounting for treatment discontinuation and general mortality. Results Baseline mean age of the cohort was 67 years, most were White (79%) and male (56%). A majority had established coronary artery disease (75%), 48% had diabetes, and mean LDL-C was 103.0 mg/dL. After 1 year, 79% of patients achieved LDL-C goal (mean, 61.1 mg/dL) with BA + EZE (FDC) compared to 58% and 42% with EZE (71.7 mg/dL) and NOAT (78.4 mg/dL), respectively. Conclusions This simulation shows that adding BA + EZE (FDC) to maximally tolerated statins would result in more patients achieving LDL-C goal than adding EZE alone or NOAT.
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Affiliation(s)
| | | | - Anand Gupta
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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2
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Onishchenko D, Rubin DS, van Horne JR, Ward RP, Chattopadhyay I. Cardiac Comorbidity Risk Score: Zero-Burden Machine Learning to Improve Prediction of Postoperative Major Adverse Cardiac Events in Hip and Knee Arthroplasty. J Am Heart Assoc 2022; 11:e023745. [PMID: 35904198 PMCID: PMC9375497 DOI: 10.1161/jaha.121.023745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background In this retrospective, observational study we introduce the Cardiac Comorbidity Risk Score, predicting perioperative major adverse cardiac events (MACE) after elective hip and knee arthroplasty. MACE is a rare but important driver of mortality, and existing tools, eg, the Revised Cardiac Risk Index demonstrate only modest accuracy. We demonstrate an artificial intelligence-based approach to identify patients at high risk of MACE within 4 weeks (primary outcome) of arthroplasty, that imposes zero additional burden of cost/resources. Methods and Results Cardiac Comorbidity Risk Score calculation uses novel machine learning to estimate MACE risk from patient electronic health records, without requiring blood work or access to any demographic data beyond that of sex and age, and accounts for variable/missing/incomplete information across patient records. Validated on a deidentified cohort (age >45 years, n=445 391), performance was evaluated using the area under the receiver operator characteristics curve (AUROC), sensitivity/specificity, positive predictive value, and positive/negative likelihood ratios. In our cohort (age 63.5±10.5 years, 58.2% women, 34.2%/65.8% hip/knee procedures), 0.19% (882) experienced the primary outcome. Cardiac Comorbidity Risk Score achieved area under the receiver operator characteristics curve=80.0±0.4% (95% CI) for women and 80.1±0.5% (95% CI) for males, with 36.4% and 35.1% sensitivities, respectively, at 95% specificity, significantly outperforming Revised Cardiac Risk Index across all studied age-, sex-, risk-, and comorbidity-based subgroups. Conclusions Cardiac Comorbidity Risk Score, a novel artificial intelligence-based screening tool using known and unknown comorbidity patterns, outperforms state-of-the-art in predicting MACE within 4 weeks postarthroplasty, and can identify patients at high risk that do not demonstrate traditional risk factors.
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Affiliation(s)
| | - Daniel S Rubin
- Department of Anesthesia and Critical Care University of Chicago IL
| | | | - R Parker Ward
- Department of Medicine University of Chicago IL.,Section of Cardiology University of Chicago IL
| | - Ishanu Chattopadhyay
- Department of Medicine University of Chicago IL.,Committee on Genetics, Genomics & Systems Biology University of Chicago IL.,Committee on Quantitative Methods in Social, Behavioral, and Health Sciences University of Chicago IL.,Section of Hospital Medicine University of Chicago IL
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Chan YC, Yeh CH, Li LC, Chen CL, Wang CC, Lin CC, Ong AD, Chiou TY, Yong CC. Excess Risk of Major Adverse Cardiovascular and Kidney Events after Acute Kidney Injury following Living Donor Liver Transplantation. J Clin Med 2022; 11:jcm11113100. [PMID: 35683487 PMCID: PMC9181469 DOI: 10.3390/jcm11113100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/26/2022] [Accepted: 05/29/2022] [Indexed: 12/01/2022] Open
Abstract
Acute kidney injury (AKI) is a well-known risk factor for major adverse kidney events (MAKE) and major adverse cardiovascular events (MACE) in nontransplant settings. However, the association between AKI after liver transplantation (LT) and MACE/MAKE is not established. A retrospective cohort analysis including 512 LT recipients was conducted. The incidence of post-LT AKI was 35.0% (n = 179). In total, 13 patients (2.5%) developed de novo coronary artery disease (CAD), 3 patients (0.6%) diagnosed with heart failure (HF), and 11 patients (2.1%) had stroke. The post-LT AKI group showed a higher incidence of CAD and HF than the no post-LT AKI group (4.5% versus 1.5%, p = 0.042; 1.7% versus 0%, p = 0.018; respectively), while there was no significant difference in the stroke events (2.8% versus 1.8%, p = 0.461). Through Cox regression analysis, history of cardiovascular disease (HR 6.51, 95% CI 2.43–17.46), post-LT AKI (HR 3.06, 95% CI 1.39–6.75), and pre-LT diabetes (HR 2.37, 95% CI 1.09–5.17) were identified as independent predictors of MACE; pre-LT chronic kidney disease (HR 9.54, 95% CI 3.49–26.10), pre-LT diabetes (HR 3.51, 95% CI 1.25–9.86), and post-LT AKI (HR 6.76, 95% CI 2.19–20.91) were risk factors for end-stage renal disease. Post-LT AKI is predictive for the development of MACE and MAKE.
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Affiliation(s)
- Yi-Chia Chan
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (Y.-C.C.); (C.-H.Y.); (C.-L.C.); (C.-C.W.); (C.-C.L.); (A.D.O.)
| | - Cheng-Hsi Yeh
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (Y.-C.C.); (C.-H.Y.); (C.-L.C.); (C.-C.W.); (C.-C.L.); (A.D.O.)
| | - Lung-Chih Li
- Liver Transplantation Center, Department of Internal Medicine, Division of Nephrology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (L.-C.L.); (T.-Y.C.)
| | - Chao-Long Chen
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (Y.-C.C.); (C.-H.Y.); (C.-L.C.); (C.-C.W.); (C.-C.L.); (A.D.O.)
| | - Chih-Chi Wang
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (Y.-C.C.); (C.-H.Y.); (C.-L.C.); (C.-C.W.); (C.-C.L.); (A.D.O.)
| | - Chih-Chi Lin
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (Y.-C.C.); (C.-H.Y.); (C.-L.C.); (C.-C.W.); (C.-C.L.); (A.D.O.)
| | - Aldwin D. Ong
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (Y.-C.C.); (C.-H.Y.); (C.-L.C.); (C.-C.W.); (C.-C.L.); (A.D.O.)
| | - Ting-Yu Chiou
- Liver Transplantation Center, Department of Internal Medicine, Division of Nephrology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (L.-C.L.); (T.-Y.C.)
| | - Chee-Chien Yong
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (Y.-C.C.); (C.-H.Y.); (C.-L.C.); (C.-C.W.); (C.-C.L.); (A.D.O.)
- Correspondence: ; Tel.: +886-7-7317123 (ext. 8093)
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Bosco E, Hsueh L, McConeghy KW, Gravenstein S, Saade E. Major adverse cardiovascular event definitions used in observational analysis of administrative databases: a systematic review. BMC Med Res Methodol 2021; 21:241. [PMID: 34742250 PMCID: PMC8571870 DOI: 10.1186/s12874-021-01440-5] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/12/2021] [Indexed: 12/28/2022] Open
Abstract
Background Major adverse cardiovascular events (MACE) are increasingly used as composite outcomes in randomized controlled trials (RCTs) and observational studies. However, it is unclear how observational studies most commonly define MACE in the literature when using administrative data. Methods We identified peer-reviewed articles published in MEDLINE and EMBASE between January 1, 2010 to October 9, 2020. Studies utilizing administrative data to assess the MACE composite outcome using International Classification of Diseases 9th or 10th Revision diagnosis codes were included. Reviews, abstracts, and studies not providing outcome code definitions were excluded. Data extracted included data source, timeframe, MACE components, code definitions, code positions, and outcome validation. Results A total of 920 articles were screened, 412 were retained for full-text review, and 58 were included. Only 8.6% (n = 5/58) matched the traditional three-point MACE RCT definition of acute myocardial infarction (AMI), stroke, or cardiovascular death. None matched four-point (+unstable angina) or five-point MACE (+unstable angina and heart failure). The most common MACE components were: AMI and stroke, 15.5% (n = 9/58); AMI, stroke, and all-cause death, 13.8% (n = 8/58); and AMI, stroke and cardiovascular death 8.6% (n = 5/58). Further, 67% (n = 39/58) did not validate outcomes or cite validation studies. Additionally, 70.7% (n = 41/58) did not report code positions of endpoints, 20.7% (n = 12/58) used the primary position, and 8.6% (n = 5/58) used any position. Conclusions Components of MACE endpoints and diagnostic codes used varied widely across observational studies. Variability in the MACE definitions used and information reported across observational studies prohibit the comparison, replication, and aggregation of findings. Studies should transparently report the administrative codes used and code positions, as well as utilize validated outcome definitions when possible. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01440-5.
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Affiliation(s)
- Elliott Bosco
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA. .,Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, Providence, USA.
| | - Leon Hsueh
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kevin W McConeghy
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA.,Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, Providence, USA.,Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Stefan Gravenstein
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA.,Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, Providence, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Elie Saade
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Sarcopenia predicts adverse outcomes in an elderly population with coronary artery disease: a systematic review and meta-analysis. BMC Geriatr 2021; 21:493. [PMID: 34521369 PMCID: PMC8439080 DOI: 10.1186/s12877-021-02438-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/26/2021] [Indexed: 01/07/2023] Open
Abstract
Background The development of sarcopenia is attributed to normal aging and factors like type 2 diabetes, obesity, inactivity, reduced testosterone levels, and malnutrition, which are factors of poor prognosis in patients with coronary artery disease (CAD). This study aimed to perform a meta-analysis to assess whether preoperative sarcopenia can be used to predict the outcomes after cardiac surgery in elderly patients with CAD. Methods PubMed, Embase, the Cochrane library, and Web of Science were searched for available papers published up to December 2020. The primary outcome was major adverse cardiovascular outcomes (MACE). The secondary outcomes were mortality and heart failure (HF)-related hospitalization. The random-effects model was used. Hazard ratios (HRs) with 95% confidence intervals (95%CIs) were estimated. Results Ten studies were included, with 3707 patients followed for 6 months to 4.5 ± 2.3 years. The sarcopenia population had a higher rate of MACE compared to the non-sarcopenia population (HR = 2.27, 95%CI: 1.58–3.27, P < 0.001; I2 = 60.0%, Pheterogeneity = 0.02). The association between sarcopenia and MACE was significant when using the psoas muscle area index (PMI) to define sarcopenia (HR = 2.86, 95%CI: 1.84–4.46, P < 0.001; I2 = 0%, Pheterogeneity = 0.604). Sarcopenia was not associated with higher late mortality (HR = 2.15, 95%CI: 0.89–5.22, P = 0.090; I2 = 91.0%, Pheterogeneity < 0.001), all-cause mortality (HR = 1.35, 95%CI: 0.14–12.84, P = 0.792; I2 = 90.5%, Pheterogeneity = 0.001), and death, HF-related hospitalization (HR = 1.37, 95%CI: 0.59–3.16, P = 0.459; I2 = 62.0%, Pheterogeneity = 0.105). The sensitivity analysis revealed no outlying study in the analysis of the association between sarcopenia and MACE after coronary intervention. Conclusion Sarcopenia is associated with poor MACE outcomes in patients with CAD. The results could help determine subpopulations of patients needing special monitoring after CAD surgery. The present study included several kinds of participants; although non-heterogeneity was found, interpretation should be cautious. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02438-w.
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Zhu Y, Liu C, Zhang L, Fang Q, Zang S, Wang X. How to control the economic burden of treating cardio-cerebrovascular diseases in China? Assessment based on System of Health Accounts 2011. J Glob Health 2020; 10:010802. [PMID: 32373337 PMCID: PMC7182356 DOI: 10.7189/jogh.10.010802] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background In the past two decades, chronic non-communicable diseases have become the leading disease burden, and cardio-cerebrovascular diseases (CCVD) are the main causes of death in chronic diseases. It has become the focus of global public health attention, in this study, System of Health Accounts 2011 (SHA 2011) is used to calculate health expenditure, discuss its economic burden, and put forward countermeasures. Methods Data were collected by multi-stage stratified random sampling and the medical expenses of patients with CCVD were calculated based on SHA 2011, from the dimensions of the financing plan, institutional flow, and service function. Correlation and regression analysis were conducted by controlling factors influencing hospitalization expenses. All analysis were conducted by software SPSS. Results The current health expenditure (CHE) of CCVD in Dalian was 3.986 billion Yuan, accounting for 12.88% of the CHE (30.947 billion Yuan). The current curative expenditure (CCE) of CCVD was 2.947 billion Yuan. 40.39% of CCVD financing came from social medical insurance, and the proportion of family health financing was higher (39.06%). The expenditures were consumed by general hospitals and elderly patients. Conclusions The expenditure burden of CCVD in Dalian was massive, and wasted the health resource severely. It is necessary for the government to adjust the financing structure, reallocate the expenses of CCVD, and make institutional flow and functional distribution more reasonable.
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Affiliation(s)
- Yalan Zhu
- College of Humanities and Social Sciences, China Medical University, Shenyang, China
| | - Chunping Liu
- Administration School, Hainan Medical University, Haikou, China
| | - Luwen Zhang
- School of Health Services Management, Southern Medical University, Guangzhou, China
| | - Quan Fang
- College of Humanities and Social Sciences, China Medical University, Shenyang, China
| | - Shuang Zang
- School of Nursing, China Medical University, Shenyang, China
| | - Xin Wang
- College of Humanities and Social Sciences, China Medical University, Shenyang, China
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Ko T, Yang CH, Mao CT, Kuo LT, Hsieh MJ, Chen DY, Wang CY, Lin YS, Hsieh IC, Chen SW, Hung MJ, Cherng WJ, Chen TH. Effects of National Hospital Accreditation in Acute Coronary Syndrome on In-Hospital Mortality and Clinical Outcomes. ACTA CARDIOLOGICA SINICA 2020; 36:416-427. [PMID: 32952351 DOI: 10.6515/acs.202009_36(5).20200421a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Acute coronary syndrome (ACS) is a life-threatening medical condition that accounts for an annual expenditure of more than $300 billion in the United States. Hospital accreditation has been shown to improve patient and hospital outcomes for various conditions. Objectives This study aimed to determine the benefits of hospital accreditation in patients with ACS. Methods This nationwide population-based cohort study used Taiwan's National Health Insurance Research Database from 1997 to 2011 (n = 249,354). Multivariable logistic regression was used to analyze the risk of in-hospital events among those treated in accredited and non-accredited hospitals, and to compare outcomes in hospitals before and after accreditation. The effect of accreditation on these events was also stratified by accreditation grade. Results A total of 823 hospitals were included, of which 2.4% were medical centers, 13.7% were regional hospitals, and 83.8% were district hospitals. The in-hospital mortality [odds ratio (OR), 0.82; 95% confidence interval (CI), 0.79-0.85; p < 0.001] and recurrent acute myocardial infarction (AMI) admission (OR, 0.81; 95% CI, 0.71-0.93; p = 0.003) rates were significantly lower in the after-accreditation group than in the before-accreditation group. There was a substantial and marked decrease in the in-hospital mortality rate after accreditation in 2008. Conclusions This cohort study demonstrated that ACS accreditation was associated with better in-hospital mortality and recurrent AMI admission rates in ACS patients.
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Affiliation(s)
- Ta Ko
- Division of Cardiology, Department of Internal Medicine, Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung; Chang Gung University College of Medicine, Taoyuan
| | - Chia-Hung Yang
- Division of Cardiology, Department of Internal Medicine, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital, Linkou; Chang Gung University College of Medicine, Taoyuan
| | - Chun-Tai Mao
- Division of Cardiology, Department of Internal Medicine, Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung; Chang Gung University College of Medicine, Taoyuan
| | - Li-Tang Kuo
- Division of Cardiology, Department of Internal Medicine, Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung; Chang Gung University College of Medicine, Taoyuan
| | - Ming-Jer Hsieh
- Division of Cardiology, Department of Internal Medicine, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital, Linkou; Chang Gung University College of Medicine, Taoyuan
| | - Dong-Yi Chen
- Division of Cardiology, Department of Internal Medicine, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital, Linkou; Chang Gung University College of Medicine, Taoyuan
| | - Chao-Yung Wang
- Division of Cardiology, Department of Internal Medicine, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital, Linkou; Chang Gung University College of Medicine, Taoyuan
| | - Yu-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi; Chang Gung University College of Medicine, Taoyuan
| | - I-Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital, Linkou; Chang Gung University College of Medicine, Taoyuan
| | - Shao-Wei Chen
- Department of Cardiac Surgery, Chang Gung Memorial Hospital, Linkou; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Jui Hung
- Division of Cardiology, Department of Internal Medicine, Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung; Chang Gung University College of Medicine, Taoyuan
| | - Wen-Jin Cherng
- Division of Cardiology, Department of Internal Medicine, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital, Linkou; Chang Gung University College of Medicine, Taoyuan
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Internal Medicine, Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung; Chang Gung University College of Medicine, Taoyuan
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Wang G, Zhao Q, Cheng Q, Zhang X, Tian L, Wu X. Comparison short time discharge with long time discharge following uncomplicated percutaneous coronary intervention for Non-ST elevation myocardial infarction patients. BMC Cardiovasc Disord 2019; 19:109. [PMID: 31088360 PMCID: PMC6518450 DOI: 10.1186/s12872-019-1096-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 05/03/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The rational length of stay following non-complicated percutaneous coronary intervention (PCI) for Non-ST elevation myocardial infarction (NSTEMI) patients remains controversial. Few studies have examined the impact of early discharge on short-term outcomes in NSTEMI patients, but short-time discharge is not uncommon in real world practice. This study examined the impact of short time discharge following non-complicated PCI on 30-day net adverse clinical events in NSTEMI patients. METHODS This retrospective study enrolled 1424 consecutive patients with NSTEMI diagnoses who underwent non-complicated PCI. Of these patients, 432 were discharged early (< 24 h), whereas the remaining 992 NSTEMI patients underwent routine discharge. The primary end points of the study were the net adverse clinical events including major adverse cardiac or cerebral events or access site vascular/bleeding complications within 30 days. The differences between the two groups were analyzed after propensity score matching to reduce selection bias. RESULTS The incidence of crude 30-day net adverse events was numerically higher in the long-time discharge group at 11.6% (115/992) compared with 8.6% (37/432) in the short-time discharge group, although this difference was not significant (P = 0.09). This difference was mainly due to lesser radial access selected in the long-time discharge group (827/932, 83.4% vs. 387/432, 89.5%, P < 0.0005). After PS matching to balance the access difference, there was no significant difference in the incidence of the events mentioned above between two groups. CONCLUSIONS If an NSTEMI patient undergoes PCI without any procedural or hospital complications, short-time discharge after successful PCI would be feasible and safe in selected NSTEMI patients.
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Affiliation(s)
- Guozhong Wang
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China.
| | - Quanming Zhao
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
| | - Qing Cheng
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
| | - Xiaoxia Zhang
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
| | - Lei Tian
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
| | - Xiaofan Wu
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
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Cost-effectiveness of increased influenza vaccination uptake against readmissions of major adverse cardiac events in the US. PLoS One 2019; 14:e0213499. [PMID: 31034485 PMCID: PMC6488048 DOI: 10.1371/journal.pone.0213499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 02/23/2019] [Indexed: 12/01/2022] Open
Abstract
Background Although influenza vaccination has been shown to reduce the incidence of major adverse cardiac events (MACE) among those with existing cardiovascular disease (CVD), in the 2015–16 season, coverage for persons with heart disease was only 48% in the US. Methods We built a Monte Carlo (probabilistic) spreadsheet-based decision tree in 2018 to estimate the cost-effectiveness of increased influenza vaccination to prevent MACE readmissions. We based our model on current US influenza vaccination coverage of the estimated 493,750 US acute coronary syndrome (ACS) patients from the healthcare payer perspective. We excluded outpatient costs and time lost from work and included only hospitalization and vaccination costs. We also estimated the incremental cost/MACE case averted and incremental cost/QALY gained (ICER) if 75% hospitalized ACS patients were vaccinated by discharge and estimated the impact of increasing vaccination coverage incrementally by 5% up to 95% in a sensitivity analysis, among hospitalized adults aged ≥ 65 years and 18–64 years, and varying vaccine effectiveness from 30–40%. Result At 75% vaccination coverage by discharge, vaccination was cost-saving from the healthcare payer perspective in adults ≥ 65 years and the ICER was $12,680/QALY (95% CI: 6,273–20,264) in adults 18–64 years and $2,400 (95% CI: -1,992–7,398) in all adults 18 + years. These resulted in ~ 500 (95% CI: 439–625) additional averted MACEs/year for all adult patients aged ≥18 years and added ~700 (95% CI: 578–825) QALYs. In the sensitivity analysis, vaccination becomes cost-saving in adults 18+years after about 80% vaccination rate. To achieve 75% vaccination rate in all adults aged ≥ 18 years will require an additional cost of $3 million. The effectiveness of the vaccine, cost of vaccination, and vaccination coverage rate had the most impact on the results. Conclusion Increasing vaccination rate among hospitalized ACS patients has a favorable cost-effectiveness profile and becomes cost-saving when at least 80% are vaccinated.
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Heile M, Wyne K, Billings LK, Cannon A, Handelsman Y, Shannon M. Cardiovascular Outcomes with Once-Weekly GLP-1 RAs: Clinical and Economic Implications. J Manag Care Spec Pharm 2018; 24:S42-S52. [PMID: 30156446 PMCID: PMC10408396 DOI: 10.18553/jmcp.2018.24.9-a.s42] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Type 2 diabetes mellitus (T2DM) is associated with an increased risk of atherosclerotic cardiovascular (ASCVD) disease, which is the largest contributor to the economic burden of diabetes. Minimization of disease morbidity through comprehensive management of ASCVD risk factors, including but not limited to hyperglycemia, is a key goal of T2DM therapy. Emerging evidence with some glucagon-like peptide-1 receptor agonists (GLP-1 RAs) points to beneficial effects across a range of atherosclerotic risk factors and possible improvement of some cardiovascular outcomes independent of these effects. Given these benefits, there has been substantial interest in evaluating the cardiovascular safety of GLP-1 RAs as well as their potential to reduce the risk of major adverse cardiac events (MACE). Following the superior clinical outcome with the once-daily GLP-1 RA liraglutide (Liraglutide Effect and Action in Diabetes: Evaluation of cardiovascular outcome Results [LEADER]), this review examines and summarizes the effects of once-weekly GLP-1 RAs, including exenatide extended release (ER), dulaglutide, and semaglutide, on reducing cardiovascular events in patients with T2DM. A phase 3 cardiovascular outcomes trial (EXSCEL) of exenatide ER found no significant difference between exenatide ER and placebo in reducing MACE in patients with T2DM. In a phase 3 premarketing trial in T2DM patients at high risk of cardiovascular disease (SUSTAIN-6), semaglutide significantly reduced the risks of MACE and non-fatal stroke compared with placebo. A phase 3 study (REWIND) is underway to evaluate the effects of dulaglutide on MACE. Considering the substantial costs of cardiovascular disease in patients with T2DM, it will be of interest to assess the impact of treatment with once-weekly GLP-1 RAs on cardiovascular disease-related costs among patients with T2DM. DISCLOSURES This supplement was funded by Novo Nordisk. Heile reports speaker fees from and has served as advisor to Novo Nordisk. Billings reports personal fees from Dexcom, Novo Nordisk, and Sanofi. Cannon reports speaker fees and owns stock in Novo Nordisk. Handelsman reports research grants from Amgen, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Grifols, Janssen, Lexicon, Merck, Novo Nordisk, Regeneron, and Sanofi; speaker fees from Amarin, Amgen, AstraZeneca, Boehringer Ingelheim-Lilly, Janssen, Merck, Novo Nordisk, Regeneron, and Sanofi; and has served in advisory capacity to Amarin, Amgen, AstraZeneca, Boehringer Ingelheim, Eisai, Intarcia, Janssen, Lilly, Merck, Merck-Pfizer, Novo Nordisk, Regeneron, and Sanofi. Shannon reports consultant and speaker fees from Novo Nordisk and Boehringer Ingelheim-Lilly Alliance. Wyne has nothing to disclose.
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Affiliation(s)
| | - Kathleen Wyne
- 2 The Ohio State University Wexner Medical Center, Columbus
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11
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Abdelnoor M, Andersen JG, Arnesen H, Johansen O. Early discharge compared with ordinary discharge after percutaneous coronary intervention - a systematic review and meta-analysis of safety and cost. Vasc Health Risk Manag 2017; 13:101-109. [PMID: 28356750 PMCID: PMC5367460 DOI: 10.2147/vhrm.s122951] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Aim We aimed to summarize the pooled effect of early discharge compared with ordinary discharge after percutaneous coronary intervention (PCI) on the composite endpoint of re-infarction, revascularization, stroke, death, and incidence of rehospitalization. We also aimed to compare costs for the two strategies. Methods The study was a systematic review and a meta-analysis of 12 randomized controlled trials including 2962 patients, followed by trial sequential analysis. An estimation of cost was considered. Follow-up time was 30 days. Results For early discharge, pooled effect for the composite endpoint was relative risk of efficacy (RRe)=0.65, 95% confidence interval (CI) (0.52–0.81). Rehospitalization had a pooled effect of RRe=1.10, 95% CI (0.88–1.38). Early discharge had an increasing risk of rehospitalization with increasing frequency of hypertension for all populations, except those with stable angina, where a decreasing risk was noted. Advancing age gave increased risk of revascularization. Early discharge had a cost reduction of 655 Euros per patient compared with ordinary discharge. Conclusion The pooled effect supports the safe use of early discharge after PCI in the treatment of a heterogeneous population of patients with coronary artery disease. There was an increased risk of rehospitalization for all subpopulations, except patients with stable angina. Clinical trials with homogeneous populations of acute coronary syndrome are needed to be conclusive on this issue.
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Affiliation(s)
- Michael Abdelnoor
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway; Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jack Gunnar Andersen
- Clinic of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Harald Arnesen
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo Norway
| | - Odd Johansen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
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Schlyter M, Östman M, Engström G, André-Petersson L, Tydén P, Leosdottir M. Personality factors and depression as predictors of hospital-based health care utilization following acute myocardial infarction. Eur J Cardiovasc Nurs 2016; 16:318-325. [DOI: 10.1177/1474515116666780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mona Schlyter
- Department of Cardiology, Skåne University Hospital and Lund University, Lund and Malmö, Sweden
- Faculty of Health and Society, Malmö University, Sweden
| | | | - Gunnar Engström
- Cardiovascular Epidemiology Research Group, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | | | - Patrik Tydén
- Department of Cardiology, Skåne University Hospital and Lund University, Lund and Malmö, Sweden
| | - Margrét Leosdottir
- Department of Cardiology, Skåne University Hospital and Lund University, Lund and Malmö, Sweden
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