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Stroke cost cost-effective

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https://www.readbyqxmd.com/read/28737070/%C3%AE-blockers-on-discharge-from-acute-atrial-fibrillation-are-associated-with-decreased-mortality-and-lower-cerebrovascular-accidents-in-patients-with-heart-failure-and-reduced-ejection-fraction
#1
Charbel Abi Khalil, Mohammad Zubaid, Nidal Asaad, Wafa A Rashed, Adel Khalifa Hamad, Rajvir Singh, Jassim Al Suwaidi
The benefits of β-blockers in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) are controversial. The Gulf Survey of Atrial Fibrillation Events was a prospective, multinational, observational registry of consecutive patients with AF recruited from the emergency department (ED). We studied the incidence of 6- and 12-month mortality, hospitalization for HF or AF, and stroke/transient ischemic attacks (TIAs) in patients with HFrEF, in relation to β-blockers on discharge from the ED or the subsequent hospital stay...
January 1, 2017: Angiology
https://www.readbyqxmd.com/read/28736623/a-literature-review-of-cost-effectiveness-of-intravenous-recombinant-tissue-plasminogen-activator-for-treating-acute-ischemic-stroke
#2
Heesoo Joo, Guijing Wang, Mary G George
BACKGROUND: Intravenous recombinant tissue plasminogen activator (IV rtPA) is recommended treatment for acute ischemic stroke patients, but the cost-effectiveness of IV rtPA within different time windows after the onset of acute ischemic stroke is not well reviewed. AIMS: To conduct a literature review of the cost-effectiveness studies about IV rtPA by treatment times. SUMMARY OF REVIEW: A literature search was conducted using MEDLINE, EMBASE, CINAHL and Cochrane Library, with the key words acute ischemic stroke, tissue plasminogen activator, cost, economic benefit, saving, and incremental cost-effectiveness analysis...
2017: Stroke and Vascular Neurology
https://www.readbyqxmd.com/read/28728489/idarucizumab-for-the-treatment-of-hemorrhage-and-dabigatran-reversal-in-patients-requiring-urgent-surgery-or-procedures
#3
Ovidiu Vornicu, Anne-Sophie Larock, Anne-Sophie Dincq, Jonathan Douxfils, Jean-Michel Dogné, François Mullier, Sarah Lessire
Idarucizumab is a specific antagonist for dabigatran etexilate (DE). The recent market authorization of idarucizumab in Europe and the USA may reassure prescribers of DE, as it can increase the safety of the emergency management of patients taking this anticoagulant. However, idarucizumab use should be limited to specific indications to avoid unnecessary risks to patients and costs to healthcare systems. Areas covered: The authors provide an overview of idarucizumab development and its pharmacokinetic and pharmacodynamic properties...
July 20, 2017: Expert Opinion on Biological Therapy
https://www.readbyqxmd.com/read/28720631/accrued-cost-savings-of-a-free-clinic-using-quality-adjusted-life-years-saved-and-return-on-investment
#4
Jim Sanders, Marcus Lacey, Clare E Guse
INTRODUCTION: Savings garnered through the provision of preventive services is a form of profit for health systems. Free clinics have been using this logic to demonstrate their cost-savings. The Community-Based Chronic Disease Management (CCDM) clinic treats hypertension using nurse-led teams, clinical protocols, and community-based settings. METHODS: We calculated CCDM's cost-effectiveness from 2007 to 2013 using 2 metrics: Quality-adjusted life years (QALYs) saved and return on investment (ROI)...
July 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28716983/systematic-review-of-the-cost-and-cost-effectiveness-of-rapid-endovascular-therapy-for-acute-ischemic-stroke
#5
Laura K Sevick, Sarah Ghali, Michael D Hill, Vishva Danthurebandara, Diane L Lorenzetti, Tom Noseworthy, Eldon Spackman, Fiona Clement
BACKGROUND AND PURPOSE: Rapid endovascular therapy (EVT) is an emerging treatment option for acute ischemic stroke. Several economic evaluations have been published examining the cost-effectiveness of EVT, and many international bodies are currently making adoption decisions. The objective of this study was to establish the cost-effectiveness of EVT for ischemic stroke patients and to synthesize all the publicly available economic literature. METHODS: A systematic review of the published literature was conducted to identify economic evaluations and cost analyses of EVT for acute ischemic stroke patients...
July 17, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28716014/the-comprehensive-post-acute-stroke-services-compass-study-design-and-methods-for-a-cluster-randomized-pragmatic-trial
#6
Pamela W Duncan, Cheryl D Bushnell, Wayne D Rosamond, Sara B Jones Berkeley, Sabina B Gesell, Ralph B D'Agostino, Walter T Ambrosius, Blair Barton-Percival, Janet Prvu Bettger, Sylvia W Coleman, Doyle M Cummings, Janet K Freburger, Jacqueline Halladay, Anna M Johnson, Anna M Kucharska-Newton, Gladys Lundy-Lamm, Barbara J Lutz, Laurie H Mettam, Amy M Pastva, Mysha E Sissine, Betsy Vetter
BACKGROUND: Patients discharged home after stroke face significant challenges managing residual neurological deficits, secondary prevention, and pre-existing chronic conditions. Post-discharge care is often fragmented leading to increased healthcare costs, readmissions, and sub-optimal utilization of rehabilitation and community services. The COMprehensive Post-Acute Stroke Services (COMPASS) Study is an ongoing cluster-randomized pragmatic trial to assess the effectiveness of a comprehensive, evidence-based, post-acute care model on patient-centered outcomes...
July 17, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28713074/barriers-and-facilitators-to-adherence-to-secondary-stroke-prevention-medications-after-stroke-analysis-of-survivors-and-caregivers-views-from-an-online-stroke-forum
#7
James Jamison, Stephen Sutton, Jonathan Mant, Anna De Simoni
OBJECTIVE: To identify barriers and facilitators of medication adherence in patients with stroke along with their caregivers. DESIGN: Qualitative thematic analysis of posts about secondary prevention medications, informed by Perceptions and Practicalities Approach. SETTING: Posts written by the UK stroke survivors and their family members taking part in the online forum of the Stroke Association, between 2004 and 2011. PARTICIPANTS: 84 participants: 49 stroke survivors, 33 caregivers, 2 not stated, identified using the keywords 'taking medication', 'pills', 'size', 'side-effects', 'routine', 'blister' as well as secondary prevention medication terms...
July 16, 2017: BMJ Open
https://www.readbyqxmd.com/read/28712618/would-a-large-tpa-trial-for-those-4-5-to-6-0-hours-from-stroke-onset-be-good-value-for-information
#8
Djøra I Soeteman, Nicolas A Menzies, Ankur Pandya
OBJECTIVES: To quantify the potential value of new research in patients treated with thrombolytic treatment (tissue-type plasminogen activator [tPA]) in the 4.5- to 6.0-hour time window after stroke onset and to determine the optimal size of a future trial using value of information analysis. METHODS: Expected value of partial perfect and sample information (EVPPI and EVSI) analyses were conducted using a probabilistic Markov model. Data for modified Rankin Scale (mRS) distributions in patients 4...
July 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28706883/effects-of-mannitol-20-on-outcomes-in-nontraumatic-intracerebral-hemorrhage
#9
Bahram Aminmansour, Homayoun Tabesh, Majid Rezvani, Hossain Poorjafari
BACKGROUND: A large number of stroke patients are not the perfect candidate for craniotomy and invasive procedures, so providing an alternative and noninvasive method, which is applicable in terms of costs and facilities, is necessary. Thus, the present study aimed to determine the effects of mannitol 20% on outcome of the patients with nontraumatic intracerebral hemorrhage (ICH) in patients admitted to Isfahan's Al-Zahra Hospital during 2012 and 2013. MATERIALS AND METHODS: This is a clinical trial study which is conducted during 2012-2013 in Isfahan's Al-Zahra Hospital...
2017: Advanced Biomedical Research
https://www.readbyqxmd.com/read/28702113/cost-effectiveness-analysis-of-the-unfractionated-heparin-versus-low-molecular-weight-heparin-in-hospitalized-patients-with-stroke-due-to-atrial-fibrillation-in-shiraz-south-of-iran
#10
Nahid Hatam, Jamshid Bahmei, Khosro Keshavarz, Farnia Feiz, Reihaneh Sedghi, Afshin Borhani-Haghighi
BACKGROUND: Patients with atrial fibrillation (AF) make a unique group of strokes. Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) are among the medications used for preventing blood coagulation. This study was carried out aiming at analyzing the cost effectiveness of LMWH versus UFH in hospitalized patients with stroke due to AF with respect to the Iranian population. METHODS: This randomized study was an economic evaluation of cost effectiveness with the help of the cross-sectional data of 2013-2015...
June 2017: Journal of Vascular and Interventional Neurology
https://www.readbyqxmd.com/read/28701409/what-outcomes-are-associated-with-developing-and-implementing-co-produced-interventions-in-acute-healthcare-settings-a-rapid-evidence-synthesis
#11
David Clarke, Fiona Jones, Ruth Harris, Glenn Robert
BACKGROUND: Co-production is defined as the voluntary or involuntary involvement of users in the design, management, delivery and/or evaluation of services. Interest in co-production as an intervention for improving healthcare quality is increasing. In the acute healthcare context, co-production is promoted as harnessing the knowledge of patients, carers and staff to make changes about which they care most. However, little is known regarding the impact of co-production on patient, staff or organisational outcomes in these settings...
July 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/28693742/impact-of-cirrhosis-in-patients-who-underwent-surgical-aortic-valve-replacement
#12
Robert J Steffen, Faisal G Bakaeen, Patrick R Vargo, Bogdan A Kindzelski, Douglas R Johnston, Eric E Roselli, A Marc Gillinov, Lars G Svensson, Edward G Soltesz
Cirrhosis is known to adversely affect cardiac surgery outcomes. Our objective was to quantify the morbidity, mortality, and cost that cirrhosis adds to surgical aortic valve replacement. From 1998 to 2011, 423,789 patients in the Nationwide Inpatient Sample Healthcare Cost Utilization Project underwent isolated aortic valve replacement; 2,769 (0.7%) had cirrhosis. Multivariable linear regression and 1:1 propensity matching were used to determine the effect of cirrhosis on postsurgical outcomes. The number of patients with cirrhosis who underwent surgical aortic valve replacement per year more than tripled during the 13-year study period...
May 30, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28689940/carotid-body-tumor-resection-just-as-safe-without-preoperative-embolization
#13
Adrienne N Cobb, Adel Barkat, Witawat Daungjaiboon, Pegge Halandras, Paul Crisostomo, Paul C Kuo, Bernadette Aulivola
BACKGROUND: Carotid body tumors (CBT) are rare entities for which surgical resection remains the gold standard. Given their hypervascularity, preoperative embolization is often used, however, controversy exists over whether a benefit is associated. Proponents of embolization argue it minimizes blood loss and complications. Critics argue cost and stroke outweigh benefits. This study aimed to investigate the impact of embolization on outcomes following CBT resection. METHODS: Patients undergoing CBT resection were identified using the Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) for 5 states 2006-2013...
July 6, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28687710/evaluating-the-impact-and-cost-effectiveness-of-statin-use-guidelines-for-primary-prevention-of-coronary-heart-disease-and-stroke
#14
David J Heller, Pamela G Coxson, Joanne Penko, Mark J Pletcher, Lee Goldman, Michelle C Odden, Dhruv S Kazi, Kirsten Bibbins-Domingo
Background -Statins are effective in primary prevention of atherosclerotic cardiovascular disease. The 2013 American College of Cardiology/American Heart Association (ACC-AHA) guideline expands recommended statin use, but its cost-effectiveness has not been compared with other guidelines. Methods -We used the Cardiovascular Disease (CVD) Policy Model to estimate the cost-effectiveness of the ACC-AHA, relative to current use, Adult Treatment Panel III (ATP III) guidelines, and universal statin use in all men age 45-74 years and women age 55-74 years over a 10-year horizon from 2016 to 2025...
July 7, 2017: Circulation
https://www.readbyqxmd.com/read/28683732/chinese-acute-ischemic-stroke-treatment-outcome-registry-castor-protocol-for-a-prospective-registry-study-on-patterns-of-real-world-treatment-of-acute-ischemic-stroke-in-china
#15
Weiping Sun, Qianhua Ou, Zhijun Zhang, Jiazhi Qu, Yining Huang
RATIONALE: Stroke presents a serious health problem in China. Despite progresses made in recent years, there is still a lack of effective treatments for acute ischemic stroke (AIS) in clinical practices. AIMS: The Chinese Acute Ischemic Stroke Treatment Outcome Registry (CASTOR) is designed to evaluate the patterns and cost-effectiveness of current treatments for AIS in real-world settings in China. DESIGN: CASTOR is a prospective, multi-center study registered with ClinicalTrials...
July 6, 2017: BMC Complementary and Alternative Medicine
https://www.readbyqxmd.com/read/28683175/cost-effectiveness-analysis-of-30-month-vs-12-month-dual-antiplatelet-therapy-with-clopidogrel-and-aspirin-after-drug-eluting-stents-in-patients-with-acute-coronary-syndrome
#16
Minghuan Jiang, Joyce H S You
Continuation of dual antiplatelet therapy (DAPT) beyond 1 year reduces late stent thrombosis and ischemic events after drug-eluting stents (DES) but increases risk of bleeding. We hypothesized that extending DAPT from 12 months to 30 months in patients with acute coronary syndrome (ACS) after DES is cost-effective. A lifelong decision-analytic model was designed to simulate 2 antiplatelet strategies in event-free ACS patients who had completed 12-month DAPT after DES: aspirin monotherapy (75-162 mg daily) and continuation of DAPT (clopidogrel 75 mg daily plus aspirin 75-162 mg daily) for 18 months...
July 6, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28675943/do-activity-level-outcome-measures-commonly-used-in-neurological-practice-assess-upper-limb-movement-quality
#17
Marika Demers, Mindy F Levin
BACKGROUND: Movement is described in terms of task-related end point characteristics in external space and movement quality (joint rotations in body space). Assessment of upper-limb (UL) movement quality can assist therapists in designing effective treatment approaches for retraining lost motor elements and provide more detailed measurements of UL motor improvements over time. OBJECTIVE: To determine the extent to which current activity level outcome measures used in neurological practice assess UL movement quality...
July 1, 2017: Neurorehabilitation and Neural Repair
https://www.readbyqxmd.com/read/28659427/effects-of-increasing-iv-tpa-treated-stroke-mimic-rates-at-ct-based-centers-on-clinical-outcomes
#18
Tina M Burton, Marie Luby, Zurab Nadareishvili, Richard T Benson, John K Lynch, Lawrence L Latour, Amie W Hsia
OBJECTIVE: To determine to what degree stroke mimics skew clinical outcomes and the potential effects of incorrect stroke diagnosis. METHODS: This retrospective analysis of data from 2005 to 2014 included IV tissue plasminogen activator (tPA)-treated adults with clinical suspicion for acute ischemic stroke who were transferred or admitted directly to our 2 hub hospitals. Primary outcome measures compared CT-based spoke hospitals' and MRI-based hub hospitals' mimic rates, hemorrhagic transformation, follow-up modified Rankin Scale (mRS), and discharge disposition...
June 28, 2017: Neurology
https://www.readbyqxmd.com/read/28651296/early-discharge-hospital-at-home
#19
REVIEW
Daniela C Gonçalves-Bradley, Steve Iliffe, Helen A Doll, Joanna Broad, John Gladman, Peter Langhorne, Suzanne H Richards, Sasha Shepperd
BACKGROUND: Early discharge hospital at home is a service that provides active treatment by healthcare professionals in the patient's home for a condition that otherwise would require acute hospital inpatient care. This is an update of a Cochrane review. OBJECTIVES: To determine the effectiveness and cost of managing patients with early discharge hospital at home compared with inpatient hospital care. SEARCH METHODS: We searched the following databases to 9 January 2017: the Cochrane Effective Practice and Organisation of Care Group (EPOC) register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and EconLit...
June 26, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28650086/systemic-thrombolysis-catheter-directed-thrombolysis-and-anticoagulation-for-intermediate-risk-pulmonary-embolism-a-simulation-modeling-analysis
#20
Christopher Kabrhel, Ayman Ali, Jin Choi, Chin Hur
OBJECTIVES: Decision-making around the use of thrombolysis for patients with intermediate-risk (submassive) PE remains challenging. Studies indicate favorable clinical outcomes with systemic thrombolytics (IV tPA), but the risk of major bleeding and hemorrhagic stroke is a deterrent. Catheter-directed thrombolysis (CDT) may be a preferable strategy, as it has been shown to have a lower risk of bleeding than systemic thrombolysis. However, a three-arm randomized control study comparing IV tPA, CDT, and anticoagulation alone, with long-term follow up, would be costly and is unlikely to be performed...
June 26, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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