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Acute mi cost

Rhys D Pockett, Phil McEwan, Joshua Ray, Irwin Tran, Simon Shutler, Steven Martin, Zaheer Yousef, Ameet Bakhai
OBJECTIVES: The effects of acute coronary syndrome (ACS) events on health-related quality of life (HRQoL) and the time dependency of these effects are unknown. This study aimed to characterise health utilities in ACS patients to aid development of future economic models estimating the cost per quality-adjusted life-year impact of ACS events and potential treatments. METHODS: Multicentre, non-interventional, longitudinal evaluation of health utility in patients experiencing ACS or stroke events...
March 20, 2018: Journal of Medical Economics
M Martínez-García, J Vargas-Barrón, F Bañuelos-Téllez, H González-Pacheco, C Fresno, E Hernández-Lemus, M A Martínez-Ríos, M Vallejo
OBJECTIVE: ST-segment elevation myocardial infarction (STEMI) has an important economic burden that poised the urgent need to evaluate its catastrophic medical expense. This study evaluates the first 5 years of the national health initiative called Popular Insurance (PI) at the National Institute of Cardiology in Mexico. STUDY DESIGN: Retrospective data analysis. METHODS: STEMI patients with (n=317) and without (n=260) PI were selected. Analysed variables included socio-economical context, management care, cost evaluation and three outcomes (mortality, hospital readmission and therapeutic adherence)...
March 13, 2018: Public Health
Irene Papanicolas, Liana R Woskie, Ashish K Jha
Importance: Health care spending in the United States is a major concern and is higher than in other high-income countries, but there is little evidence that efforts to reform US health care delivery have had a meaningful influence on controlling health care spending and costs. Objective: To compare potential drivers of spending, such as structural capacity and utilization, in the United States with those of 10 of the highest-income countries (United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland, and Denmark) to gain insight into what the United States can learn from these nations...
March 13, 2018: JAMA: the Journal of the American Medical Association
Dennis T Ko, Harlan M Krumholz, Jack V Tu, Peter C Austin, Therese A Stukel, Maria Koh, Alice Chong, Jose Francisco de Melo, Cynthia A Jackevicius
BACKGROUND: Clopidogrel is one of the most commonly prescribed medications because of its ability to improve clinical outcomes for a broad range of cardiovascular conditions. After patent protection expired for Plavix in 2012, many healthcare systems adopted generic clopidogrel as a strategy to reduce healthcare costs. METHODS AND RESULTS: We conducted a population-based observational study to determine whether generic clopidogrel was noninferior to Plavix. Patients who were hospitalized with an acute coronary syndrome (ACS) from 2009 to 2014 in Ontario, Canada, >65 years, survived ≥7 days after discharge, were eligible for inclusion...
March 2018: Circulation. Cardiovascular Quality and Outcomes
Xu Cong Ruan, Lian Leng Low, Yu Heng Kwan
INTRODUCTION The risk of rhabdomyolysis in the general population is elevated by the increased prevalence of statin use. As the presentation of rhabdomyolysis is varied, there is a risk of delayed diagnosis leading to patient complications and increased healthcare costs. Creatine kinase (CK) alone is not sufficiently predictive for risk stratification. Beyond serum CK, other biomarkers such as transaminases may be used as surrogates to evaluate rhabdomyolysis severity and predict complication risks. AIM To assess if other biomarkers are associated with peak CK and severity of rhabdomyolysis to aid in clinical diagnosis of rhabdomyolysis...
December 2017: Journal of Primary Health Care
Nathaniel R Smilowitz, Joshua A Beckman, Scott E Sherman, Jeffrey S Berger
BACKGROUND : Acute myocardial infarction (AMI) is a major cardiovascular complication of noncardiac surgery. We aimed to evaluate the frequency, causes, and outcomes of 30-day hospital readmission after perioperative AMI. METHODS : Patients who were diagnosed with AMI during hospitalization for major noncardiac surgery were identified using the 2014 US Nationwide Readmission Database. Rates, causes, and costs of 30-day readmissions after noncardiac surgery with and without perioperative AMI were identified...
March 10, 2018: Circulation
Adina Kleinerüschkamp, Patrick Meybohm, Niels Straub, Kai Zacharowski, Suma Choorapoikayil
BACKGROUND: Patient blood management (PBM) is a multidisciplinary concept focused on the management of anaemia, minimisation of iatrogenic blood loss and rational use of allogeneic blood products. The aims of this study were: (i) to analyse post-operative outcome in patients with liberal vs restrictive exposure to allogeneic blood products and (ii) to evaluate the cost-effectiveness of PBM in patients undergoing surgery. MATERIALS AND METHODS: A systematic literature review and meta-analysis were performed to compare post-operative complications in predominantly non-transfused patients (restrictive transfusion group) and patients who received one to three units of red blood cells (liberal transfusion group)...
February 16, 2018: Blood Transfusion, Trasfusione del Sangue
Xiaolei Xiong, Zhiguo Zhang, Jing Ren, Jie Zhang, Xiaoyun Pan, Liang Zhang, Shiwei Gong, Si Jin
BACKGROUND: China's universal medical insurance system (UMIS) is designed to promote social fairness through improving access to medical services and reducing out-of-pocket (OOP) costs for all Chinese. However, it is still not known whether UMIS has a significant impact on the accessibility of medical service supply and the affordability, as well as the seeking-care choice, of patients in China. METHODS: Segmented time-series regression analysis, as a powerful statistical method of interrupted time series design, was used to estimate the changes in the quantity and quality of medical service supply before and after the implementation of UMIS...
2018: PloS One
Baharak Abd Emami, Elena Mahmoudi, Mohammad Ali Shokrgozar, Mohammad Mehdi Dehghan, Saeed Farzad Mohajeri, Nooshin Haghighipour, Seyyed Hossein Marjanmehr, Mohammad Molazem, Susan Amin, Hossein Gholami
Myocardial infarction is one of the leading causes of death all over the world. Mesenchymal stem cells (MSCs) transplantation has shown a promising potential to recovery of ischemic heart disease due to their capability in differentiating into cardiac cells. However, various investigations have been performed to optimize the efficacy of cardiac cell therapy in recent years. Here, we sought to interrogate the effect of autologous transplantation of undifferentiated and predifferentiated adipose and bone marrow-derived MSCs in a rabbit model of myocardial infarction and also to investigate whether cardiac function could be improved by mechanically induced MSCs via equiaxial cyclic strain...
March 6, 2018: Artificial Organs
M K Md Arshad, R Adzhri, M F M Fathil, Subash C B Gopinath, Nuzaihan M N M
The development of electrical biosensor towards device miniaturization in order to achieve better sensitivity with enhanced electrical signal has certain limitations especially complexity in fabrication process and costs. In this paper, an alternative technique with minor modification in the device structure is presented for signal amplification by implementing ambipolar conduction in the biosensor itself. We demonstrated the field-effect transistor (FET)-based biosensor coupled back-gate for attaining a higher sensitivity with the detection of lower target abundance...
August 1, 2018: Journal of Nanoscience and Nanotechnology
Naseer Ahmed, Yong Choe, Vikkie A Mustad, Sumita Chakraborty, Scott Goates, Menghua Luo, Jeffrey I Mechanick
Objective: The aim of this study was to examine the impact of pre-existing malnutrition on survival and economic implications in elderly patients with diabetes. Research design and methods: A retrospective observational study was conducted to examine the impact of malnutrition with or without other significant health conditions on survival time and healthcare costs using the Centers for Medicare and Medicaid Services (CMS) data from 1999 to 2014 for beneficiaries with a confirmed first date of initial diagnosis of diabetes (n=15 121 131)...
2018: BMJ Open Diabetes Research & Care
Arjun K Venkatesh, Charles D Scales, Marta E Heilbrun
Over the past twenty years, the Emergency Department (ED) has transformed from a location that managed patients with acute life-threatening illness or injury to an acute diagnostic center. The advent of rapid and accurate imaging, novel biomarkers, and other innovations concurrent with effects from financial and social forces has supported the development of an acute care system focused on "ruling out" low-frequency, high-mortality events such as acute myocardial infarction, stroke, pulmonary embolism, and aortic dissection...
February 10, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Linda Long, Lindsey Anderson, Alice M Dewhirst, Jingzhou He, Charlene Bridges, Manish Gandhi, Rod S Taylor
BACKGROUND: A previous Cochrane review has shown that exercise-based cardiac rehabilitation (CR) can benefit myocardial infarction and post-revascularisation patients. However, the impact on stable angina remains unclear and guidance is inconsistent. Whilst recommended in the guidelines of American College of Cardiology/American Heart Association and the European Society of Cardiology, in the UK the National Institute for Health and Care Excellence (NICE) states that there is "no evidence to suggest that CR is clinically or cost-effective for managing stable angina"...
February 2, 2018: Cochrane Database of Systematic Reviews
Katarzyna Pigoń, Edyta Nowak-Radzik, Tomasz Młyńczak, Grzegorz Banasik, Ewa Nowalany-Kozielska, Andrzej Tomasik
AIM: Study was aimed to assess the real-world costs of manual thrombectomy (MT) in selected ST segment-elevation myocardial infarction patients with intracoronary thrombus (IT). METHODS: Study group (IT+) comprised 51 patients with MT applied and control group (IT-) comprised 56 patients without IT who underwent angioplasty alone. Costs comprised hospital care and cost of disposable materials used during primary angioplasty. RESULTS: Complex management of patients with IT is more expensive, though allows to achieve clinical outcomes comparable to low-risk ST segment-elevation myocardial infarction patients without IT...
January 29, 2018: Journal of Comparative Effectiveness Research
Byung-Cheul Shin, Jae-Heung Cho, In-Hyuk Ha, In Heo, Jun-Hwan Lee, Koh-Woon Kim, Me-Riong Kim, So-Young Jung, Ojin Kwon, Nam-Kwen Kim, Haeng-Mi Son, Dong-Wuk Son, Kyung-Min Shin
BACKGROUND: Although pain after back surgery is known to be difficult to control, various treatment options are available to patients and physicians. A protocol for a confirmatory randomized controlled trial (RCT) on pain and function after back surgery was designed based on the results of a pilot trial. The aim of this study is to compare the effectiveness and safety of electroacupuncture (EA) with usual care (UC) versus UC alone on pain control and functional improvement after back surgery...
January 24, 2018: Trials
L Y Mi, C J Ban, Y Liu, N Bao, B Sun, M Zhu, Y H Ren, H P Dai
Objective: To analyze the clinical features of acute diffuse pulmonary exudative disorders. Methods: The data were collected from patients who were hospitalized in respiratory intensive care unit (RICU) of Beijing Chaoyang Hospital affiliated to the Capital Medical University during January 2009 to December 2011, and had acute clinical course with imaging findings of diffuse pulmonary infiltrated shadows (similar to acute respiratory distress syndrome (ARDS)). The causes of disease and clinical features were analyzed...
November 28, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Donald S Likosky, Jessica Van Parys, Weiping Zhou, William B Borden, Milton C Weinstein, Jonathan S Skinner
Importance: Many studies have considered the association between Medicare spending and health outcomes at a point in time; few have considered the association between the long-term growth in spending and outcomes. Objective: To assess whether components of growth in Medicare expenditures are associated with mortality rates between January 1, 1999, and June 30, 2014, for beneficiaries hospitalized for acute myocardial infarction. Design, Setting, and Participants: Cross-sectional analysis of a random 20% sample of fee-for-service Medicare beneficiaries from January 1, 1999, through December 31, 2000 (n=72 473) and January 1, 2004, through December 31, 2004 (n=38 248), and 100% sample from January 1, 2008, through December 31, 2008 (n=159 558) and January 1, 2013, through June 30, 2014 (n=209 614) admitted with acute myocardial infarction to 1220 hospitals...
December 20, 2017: JAMA Cardiology
Kurt Huber, Gregory Ducrocq, Christian W Hamm, Arnoud van 't Hof, Frédéric Lapostolle, Pierre Coste, Giovanni Gordini, Jacob Steinmetz, Freek W A Verheugt, Jennifer Adgey, Lutz Nibbe, Vojko Kaniĉ, Peter Clemmensen, Uwe Zeymer, Debra Bernstein, Jayne Prats, Efthymios N Deliargyris, Ph Gabriel Steg
Objective: To ascertain whether different oral P2Y12 inhibitors might affect rates of acute stent thrombosis and 30-day outcomes after primary percutaneous coronary intervention (pPCI). Methods: The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) randomised trial compared prehospital bivalirudin with heparin with optional glycoprotein IIb/IIIa inhibitor treatment in patients with ST-segment elevation myocardial infarction triaged to pPCI. Choice of P2Y12 inhibitor was at the investigator's discretion...
2017: Open Heart
Nihar R Desai, Kevin F Kennedy, David J Cohen, Traci Connolly, Deborah B Diercks, Mauro Moscucci, Stephen Ramee, John Spertus, Tracy Y Wang, Robert L McNamara
BACKGROUND: Major bleeding is a frequent complication for patients with acute myocardial infarction (AMI) and is associated with significant morbidity and mortality. OBJECTIVE: To develop a contemporary model for inhospital major bleeding that can both support clinical decision-making and serve as a foundation for assessing hospital quality. METHODS: An inhospital major bleeding model was developed using the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines (ACTION Registry-GWTG) database...
December 2017: American Heart Journal
Omar Asdrúbal Vilca Mejía, Michel Pompeu Barros Oliveira Sá, Maurilio Onofre Deininger, Luís Roberto Palma Dallan, Rodrigo Coelho Segalote, Marco Antonio Praça de Oliveira, Fernando Antibas Atik, Magaly Arrais Dos Santos, Pedro Gabriel Melo de Barros E Silva, Rodrigo Mussi Milani, Alexandre Ciappina Hueb, Rosangela Monteiro, Ricardo Carvalho Lima, Luiz Augusto Ferreira Lisboa, Luís Alberto Oliveira Dallan, John Puskas, Fabio Biscegli Jatene
INTRODUCTION: Advances in modern medicine have led to people living longer and healthier lives. Frailty is an emerging concept in medicine yet to be explored as a risk factor in cardiac surgery. When it comes to CABG surgery, randomized controlled clinical trials have primarily focused on low-risk (ROOBY, CORONARY), elevated-risk (GOPCABE) or high-risk patients (BBS), but not on frail patients. Therefore, we believe that off-pump CABG could be an important technique in patients with limited functional capacity to respond to surgical stress...
September 2017: Brazilian Journal of Cardiovascular Surgery
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