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https://www.readbyqxmd.com/read/27924429/cyp2c19-lof-and-gof-guided-antiplatelet-therapy-in-patients-with-acute-coronary-syndrome-a-cost-effectiveness-analysis
#1
Minghuan Jiang, Joyce H S You
PURPOSE: This study aimed to examine the cost-effectiveness of CYP2C19 loss-of-function and gain-of-function allele guided (LOF/GOF-guided) antiplatelet therapy in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). METHODS: A life-long decision-analytic model was designed to simulate outcomes of three strategies: universal clopidogrel (75 mg daily), universal alternative P2Y12 inhibitor (prasugrel 10 mg daily or ticagrelor 90 mg twice daily), and LOF/GOF-guided therapy (LOF/GOF allele carriers receiving alternative P2Y12 inhibitor, wild-type patients receiving clopidogrel)...
December 7, 2016: Cardiovascular Drugs and Therapy
https://www.readbyqxmd.com/read/27923390/the-rapid-ctca-trial-rapid-assessment-of-potential-ischaemic-heart-disease-with-ctca-a-multicentre-parallel-group-randomised-trial-to-compare-early-computerised-tomography-coronary-angiography-versus-standard-care-in-patients-presenting-with-suspected-or-confirmed
#2
Alasdair J Gray, Carl Roobottom, Jason E Smith, Steve Goodacre, Katherine Oatey, Rachel O'Brien, Robert F Storey, Lumine Na, Steff C Lewis, Praveen Thokala, David E Newby
BACKGROUND: Emergency department attendances with chest pain requiring assessment for acute coronary syndrome (ACS) are a major global health issue. Standard assessment includes history, examination, electrocardiogram (ECG) and serial troponin testing. Computerised tomography coronary angiography (CTCA) enables additional anatomical assessment of patients for coronary artery disease (CAD) but has only been studied in very low-risk patients. This trial aims to investigate the effect of early CTCA upon interventions, event rates and health care costs in patients with suspected/confirmed ACS who are at intermediate risk...
December 7, 2016: Trials
https://www.readbyqxmd.com/read/27922910/impact-of-medicare-s-nonpayment-program-on-hospital-acquired-conditions
#3
Caroline P Thirukumaran, Laurent G Glance, Helena Temkin-Greener, Meredith B Rosenthal, Yue Li
BACKGROUND: Medicare's Nonpayment Program of 2008 (hereafter called Program) withholds hospital reimbursement for costs related to hospital-acquired conditions (HACs). Little is known whether a hospital's Medicare patient load [quantified by the hospital's Medicare utilization ratio (MUR), which is the proportion of inpatient days financed by Medicare] influences its response to the Program. OBJECTIVE: To determine whether the Program was associated with changes in HAC incidence, and whether this association varies across hospitals with differential Medicare patient load...
December 5, 2016: Medical Care
https://www.readbyqxmd.com/read/27899069/gastric-dilatation-and-intestinal-obstruction-mimicking-acute-coronary-syndrome-with-dynamic-electrocardiographic-changes
#4
H M M T B Herath, Anne Thushara Matthias, B S D P Keragala, W A E Udeshika, Aruna Kulatunga
BACKGROUND: ST elevation myocardial infarction is a medical emergency and the electrocardiogram is a part of the mainstay in the initial diagnosis. A variety of non-cardiac conditions have been known to mimic the electrocardiographic changes seen in acute coronary syndrome. We present a patient presenting with acute partial intestinal obstruction causing gastric distension and intestinal dilatation who also had dynamic electrocardiographic changes, mimicking anterior ST elevation myocardial infarction...
November 29, 2016: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/27896982/predictive-modeling-of-hospital-readmission-rates-using-electronic-medical-record-wide-machine-learning-a-case-study-using-mount-sinai-heart-failure-cohort
#5
Khader Shameer, Kipp W Johnson, Alexandre Yahi, Riccardo Miotto, L I Li, Doran Ricks, Jebakumar Jebakaran, Patricia Kovatch, Partho P Sengupta, Sengupta Gelijns, Alan Moskovitz, Bruce Darrow, David L David, Andrew Kasarskis, Nicholas P Tatonetti, Sean Pinney, Joel T Dudley
Reduction of preventable hospital readmissions that result from chronic or acute conditions like stroke, heart failure, myocardial infarction and pneumonia remains a significant challenge for improving the outcomes and decreasing the cost of healthcare delivery in the United States. Patient readmission rates are relatively high for conditions like heart failure (HF) despite the implementation of high-quality healthcare delivery operation guidelines created by regulatory authorities. Multiple predictive models are currently available to evaluate potential 30-day readmission rates of patients...
2016: Pacific Symposium on Biocomputing
https://www.readbyqxmd.com/read/27886815/antiplatelet-therapy-for-secondary-prevention-after-acute-myocardial-infarction
#6
REVIEW
Ilaria Cavallari, Marc P Bonaca
Patients with prior myocardial infarction (MI) are at long-term heightened risk for recurrent ischemic events. Several large randomized controlled trials have demonstrated the benefit of more intensive antiplatelet strategies for long-term secondary prevention of cardiovascular death, recurrent MI, and stroke in patients with a history of MI at a cost of increased bleeding. The bleeding risk associated with long-term intensive antiplatelet strategies requires careful patient selection and involvement of patients in shared decision making regarding risks and benefits of therapy...
January 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/27881255/cost-effectiveness-analysis-of-ticagrelor-and-prasugrel-for-the-treatment-of-acute-coronary-syndrome
#7
Ying Jiao Zhao, Ai Leng Khoo, Liang Lin, Monica Teng, Tuck Seng Wu, Mark Y Chan, Boon Peng Lim
BACKGROUND: In the management of Asian patients with acute coronary syndrome (ACS), the comparative cost-effectiveness of ticagrelor and prasugrel, referenced to generic clopidogrel, is unknown. OBJECTIVE: To assess the cost-effectiveness of ticagrelor and prasugrel as compared with generic clopidogrel in patients with ACS in Singapore. METHODS: A Markov model simulating a typical cohort of 62-year-old patients with ACS was constructed from a patient's perspective over a lifetime horizon...
May 2016: Value in Health Regional Issues
https://www.readbyqxmd.com/read/27861446/preoperative-renal-insufficiency-underreporting-and-association-with-readmission-and-major-postoperative-morbidity-in-an-academic-medical-center
#8
Jeanna D Blitz, Marny H Shoham, Yixin Fang, Venod Narine, Neeraj Mehta, Beamy S Sharma, Paul Shekane, Samir Kendale
BACKGROUND: Making a formal diagnosis of chronic kidney disease (CKD) in the preoperative setting may be challenging because of lack of longitudinal data. We explored the predictive value of a single reduced preoperative estimated glomerular filtration rate (eGFR) value on adverse patient outcomes in the first 30 days after elective surgery. We compared the rate of major postoperative adverse events, including 30-day readmission rate, hospital length of stay, infection, acute kidney injury (AKI), and myocardial infarction across patients with declining preoperative eGFR values...
December 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27848189/the-impact-of-disability-and-social-determinants-of-health-on-condition-specific-readmissions-beyond-medicare-risk-adjustments-a-cohort-study
#9
Jennifer Meddings, Heidi Reichert, Shawna N Smith, Theodore J Iwashyna, Kenneth M Langa, Timothy P Hofer, Laurence F McMahon
BACKGROUND: Readmission rates after pneumonia, heart failure, and acute myocardial infarction hospitalizations are risk-adjusted for age, gender, and medical comorbidities and used to penalize hospitals. OBJECTIVE: To assess the impact of disability and social determinants of health on condition-specific readmissions beyond current risk adjustment. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of Medicare patients using 1) linked Health and Retirement Study-Medicare claims data (HRS-CMS) and 2) Healthcare Cost and Utilization Project State Inpatient Databases (Florida, Washington) linked with ZIP Code-level measures from the Census American Community Survey (ACS-HCUP)...
November 15, 2016: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/27846005/novel-emergency-department-risk-score-discriminates-acute-coronary-syndrome-among-chest-pain-patients-with-known-coronary-artery-disease
#10
Matthew T Crim, Scott A Berkowitz, Mustapha Saheed, Jason Miller, Amy Deutschendorf, Gary Gerstenblith, Peter Hill, Frederick K Korley
BACKGROUND: Patients with known coronary artery disease presenting to the emergency department (ED) with chest pain are often admitted, yet may not be having an acute coronary syndrome (ACS). METHODS: We assessed whether the use of a novel risk score and a modified thrombolysis in myocardial infarction risk score obtained in the ED could discriminate which of these high-risk patients have ACS. Chart review was performed on a cohort of 285 patients with known coronary artery disease presenting to the ED with chest pain thought to be of ischemic origin and admitted to the hospital...
December 2016: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/27811206/economic-considerations-of-early-rule-in-rule-out-algorithms-for-the-diagnosis-of-myocardial-infarction-in-the-emergency-department-using-cardiac-troponin-and-glycemic-biomarkers
#11
Colleen Shortt, Feng Xie, Richard Whitlock, Jinhui Ma, Natasha Clayton, Jonathan Sherbino, Stephen A Hill, Guillaume Pare, Matthew McQueen, Shamir R Mehta, P J Devereaux, Andrew Worster, Peter Kavsak
BACKGROUND: We have previously demonstrated the utility of a rule-in/rule-out strategy for myocardial infarction (MI) using glycemic biomarkers in combination with cardiac troponin in the emergency department (ED). Given that the cost of assessing patients with possible MI in the ED is increasing, we sought to compare the health services cost of our previously identified early rule-in/rule-out approaches for MI among patients who present to the ED with symptoms suggestive of acute coronary syndrome (ACS)...
November 3, 2016: Clinical Chemistry
https://www.readbyqxmd.com/read/27810149/diabetes-mellitus-with-chronic-complications-in-relation-to-carotid-endarterectomy-and-carotid-artery-stenting-outcomes
#12
Oluwole Adegbala, Kimberly D Martin, David Otuada, Tomi Akinyemiju
BACKGROUND: Carotid endarterectomy and carotid artery stenting are effective treatment procedures for carotid artery stenosis. Although diabetes mellitus is highly prevalent among patients undergoing these revascularization procedures, few studies have examined their impact on periprocedural outcomes. OBJECTIVES: The study aimed to determine whether perioperative outcomes among patients undergoing carotid artery stenting and carotid endarterectomy varied depending on the presence of diabetes with or without chronic complications...
October 31, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27789517/early-cessation-of-adenosine-diphosphate-receptor-inhibitors-among-acute-myocardial-infarction-patients-treated-with-percutaneous-coronary-intervention-insights-from-the-translate-acs-study-treatment-with-adenosine-diphosphate-receptor-inhibitors-longitudinal
#13
Emil L Fosbøl, Christine Ju, Kevin J Anstrom, Marjorie E Zettler, John C Messenger, Ron Waksman, Mark B Effron, Brian A Baker, David J Cohen, Eric D Peterson, Tracy Y Wang
BACKGROUND: Guidelines recommend the use of adenosine diphosphate receptor inhibitor (ADPri) therapy for 1 year postacute myocardial infarction; yet, early cessation of therapy occurs frequently in clinical practice. METHODS AND RESULTS: We examined 11 858 acute myocardial infarction patients treated with percutaneous coronary intervention discharged alive on ADPri therapy from 233 United States TRANSLATE-ACS study (Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) participating hospitals to determine the prevalence of early ADPri cessation (within 1 year), patient-reported reasons for cessation, and associated risk of major adverse cardiovascular events at 1 year...
November 2016: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/27775769/association-between-changes-in-cms-reimbursement-policy-and-drug-labels-for-erythrocyte-stimulating-agents-with-outcomes-for-older-patients-undergoing-hemodialysis-covered-by-fee-for-service-medicare
#14
Cunlin Wang, Robert Kane, Mark Levenson, Jeffrey Kelman, Michael Wernecke, Joo-Yeon Lee, Steven Kozlowski, Carmen Dekmezian, Zhiwei Zhang, Aliza Thompson, Kimberly Smith, Yu-Te Wu, Yuqin Wei, Yoganand Chillarige, Qin Ryan, Chris Worrall, Thomas E MaCurdy, David J Graham
Importance: In 2011, the US Centers for Medicare & Medicaid Services (CMS) changed its reimbursement policy for hemodialysis to a bundled comprehensive payment system that included the cost of erythrocyte-stimulating agents (ESAs). Also in 2011, the US Food and Drug Administration revised the drug label for ESAs, recommending more conservative dosing in patients with chronic kidney disease. In response to concerns that these measures could have adverse effects on patient care and outcomes, the CMS and the FDA initiated a collaboration to assess the effect...
December 1, 2016: JAMA Internal Medicine
https://www.readbyqxmd.com/read/27754515/establishing-national-noncommunicable-disease-surveillance-in-a-developing-country-a-model-for-small-island-nations
#15
Angela M Rose, Ian R Hambleton, Selvi M Jeyaseelan, Christina Howitt, Rhea Harewood, Jacqueline Campbell, Tanya N Martelly, Tracey Blackman, Kenneth S George, Trevor A Hassell, David O Corbin, Rudolph Delice, Patsy Prussia, Branka Legetic, Anselm J Hennis
Objective To describe the surveillance model used to develop the first national, population-based, multiple noncommunicable disease (NCD) registry in the Caribbean (one of the first of its kind worldwide); registry implementation; lessons learned; and incidence and mortality rates from the first years of operation. Methods Driven by limited national resources, this initiative of the Barbados Ministry of Health (MoH), in collaboration with The University of the West Indies, was designed to collect prospective data on incident stroke and acute myocardial infarction (MI) (heart attack) cases from all health care facilities in this small island developing state (SIDS) in the Eastern Caribbean...
February 2016: Revista Panamericana de Salud Pública, Pan American Journal of Public Health
https://www.readbyqxmd.com/read/27735912/-budget-impact-analysis-of-antiplatelet-therapy-with-ticagrelor-and-clopidogrel-in-patients-with-acute-coronary-syndrome-after-coronary-artery-bypass-surgery
#16
S K Zyryanov, D Yu Belousov, E V Afanas'eva, E V Dumchenko
AIM: Clinical and economic examinations were made to study whether it is appropriate to use antiplatelet therapy (APT) with ticagrelor in combination with acetylsalicylic acid (ASA) versus a combination of clopidogrel and ASA in patients with acute coronary syndrome (ACS) following coronary artery bypass surgery (CABS). MATERIAL AND METHODS: A budget impact analysis was used. Data on the efficiency and safety of APT were taken from a relevant analysis in the subgroups of the randomized controlled trial PLATO...
2016: Terapevticheskiĭ Arkhiv
https://www.readbyqxmd.com/read/27730104/relation-between-initial-treatment-strategy-in-stable-coronary-artery-disease-and-1-year-costs-in-ontario-a-population-based-cohort-study
#17
Jaskaran S Kang, Maria C Bennell, Feng Qiu, Merril L Knudtson, Peter C Austin, Dennis T Ko, Harindra C Wijeysundera
BACKGROUND: Cardiovascular disease is costly, and annual expenditures are projected to increase. Our objective was to examine the variation in patient-level costs and identify drivers of cost in patients with stable coronary artery disease. METHODS: In this retrospective cohort study using administrative databases in Ontario, Canada, we identified all patients with stable coronary artery disease after index angiography between Oct. 1, 2008, and Sept. 30, 2011. We excluded patients with a myocardial infarction within 90 days before the index, with normal coronaries, or with mild coronary disease...
July 2016: CMAJ Open
https://www.readbyqxmd.com/read/27719689/cost-effectiveness-of-structured-education-in-children-with-type-1-diabetes-mellitus
#18
Hasan Basarir, Alan Brennan, Richard Jacques, Daniel Pollard, Katherine Stevens, Jennifer Freeman, Jerry Wales, Katherine Price
OBJECTIVES: Kids in Control OF Food (KICk-OFF) is a 5-day structured education program for 11- to 16-year-olds with type 1 diabetes mellitus (T1DM) who are using multiple daily insulin injections. This study evaluates the cost-effectiveness of the KICk-OFF education program compared with the usual care using data from the KICk-OFF trial. METHODS: The short-term within-trial analysis covers the 2-year postintervention period. Data on glycated hemoglobin (HbA1c), severe hypoglycemia, and diabetic ketoacidosis (DKA) were collected over a 2-year follow-up period...
January 2016: International Journal of Technology Assessment in Health Care
https://www.readbyqxmd.com/read/27703385/patient-level-costs-of-major-cardiovascular-conditions-a-review-of-the-international-literature
#19
Gina Nicholson, Shravanthi R Gandra, Ronald J Halbert, Akshara Richhariya, Robert J Nordyke
OBJECTIVE: Robust cost estimates of cardiovascular (CV) events are required for assessing health care interventions aimed at reducing the economic burden of major adverse CV events. This review synthesizes international cost estimates of CV events. METHODS: MEDLINE database was searched electronically for English language studies published during 2007-2012, with cost estimates for CV events of interest - unstable angina, myocardial infarction, heart failure, stroke, and CV revascularization...
2016: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/27688833/economic-burden-of-toxicities-associated-with-treating-metastatic-melanoma-in-the-united-states
#20
S Pinar Bilir, Qiufei Ma, Zhongyun Zhao, Elizabeth Wehler, Julie Munakata, Beth Barber
BACKGROUND: Little has been reported on the costs of managing the adverse events (AEs) associated with current therapies for patients with regional or distant metastatic melanoma. OBJECTIVES: To identify treatment-related AEs in patients with metastatic melanoma and to estimate the associated costs of treating these AEs in the United States. METHODS: A cost-estimation study for AEs associated with treatment of metastatic melanoma was conducted from 2012 to 2013 by identifying grades 3 and 4 AEs through the use of a comprehensive search of drug labels and English-language, published phase 2/3 studies in PubMed, conference abstracts, and the National Comprehensive Cancer Network guidelines...
June 2016: American Health & Drug Benefits
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