1,721,081 research outputs found
The Economic Crisis and Acute Myocardial Infarction: New Evidence Using Hospital-Level Data.
Full text linkThis research sought to assess whether and to what extent the ongoing economic crisis in Italy impacted hospitalizations, in-hospital mortality and expenditures associated with acute myocardial infarction (AMI).The data were obtained from the hospital discharge database of the Italian Health Ministry and aggregated at the hospital level. Each hospital (n = 549) was observed for 4 years and was geographically located within a "Sistema Locale del Lavoro" (SLL, i.e., clusters of neighboring towns with a common economic structure). For each SLL, the intensity of the crisis was determined, defined as the 2012-2008 increase in the area-specific unemployment rate. A difference-in-differences (DiD) approach was employed to compare the increases in AMI-related outcomes across different quintiles of crisis intensity.Hospitals located in areas with the highest intensity of crisis (in the fifth quintile) had an increase of approximately 30 AMI cases annually (approximately 13%) compared with hospitals in area with lower crisis intensities (p<0.001). A significant increase in total hospital days was observed (13%, p<0.001) in addition to in-hospital mortality (17%, p<0.001). As a consequence, an increase of around €350.000 was incurred in annual hospital expenditures for AMI (approximately 36%, p<0.001).More attention should be given to the increase in health needs associated with the financial crisis. Policies aimed to contrast unemployment in the community by keeping and reintegrating workers in jobs could also have positive impacts on adverse health outcomes, especially in areas of high crisis intensity
Percutaneous revascularization in non-ST-elevation acute coronary syndromes: complete or incomplete?
No full textNon-ST-elevation myocardial infarction with multivessel coronary disease is increasing in patients presenting with acute coronary syndrome (ACS) and it is associated with a high rate of mortality. Complete revascularization may reduce major adverse cardiac events in patients with ACS. However, the preferred revascularization strategies (complete vs incomplete) of non-culprit lesions in this setting, as well as the correct timing of revascularization are still matters of debate. This is mostly related to the heterogeneity of patients with this clinical presentation, who are often older and affected by multiple comorbidities. The present review aims to evaluate this topic highlighting the pros and cons of complete revascularization according to anatomical or functional and imaging evaluation and based on timing and patient's clinical phenotype
Real-world cost effectiveness of MitraClip combined with medical therapy versus medical therapy alone in patients with moderate or severe mitral regurgitation
No full textBackground:Weevaluated the real-world cost-effectiveness of theMitraClip system (Abbott Vascular Inc., Menlo Park, CA) plusmedical therapy for patientswithmoderate/severe mitral regurgitation, as comparedwithmedical therapy (MT) alone.
Methods: Clinical records of patients with moderate to severe functional mitral regurgitation treated with MitraClip (N=232) or with MT (N=151) were collected and outcome analyzed with propensity score adjustment to reduce selection bias. Twelve-month outcomes were modeled over a lifetime horizon to conduct a costeffectiveness analysis, in the payer's perspective. Costs and benefits were discounted at an annual rate of 3.5%. Results: After propensity score adjustment, the average treatment effect was −9.5% probability of dying at 12 months and, following lifetime modeling, 3.35 ± 0.75 incremental life years and 3.01 ± 0.57 incremental quality-adjusted life years. MitraClip contributed to a higher decrease in re-hospitalizations at 12 months (difference = −0.54 ± 0.08) and generated a more likely improvement in the New York Heart Association (NYHA) class at 12 months versus NYHA at enrollment. Incremental costs, adapted to five possible scenarios, ranged from 14,493 to 29,795 € contributing to an incremental cost-effectiveness ratio ranging from 4796 to 7908 €.
Conclusions: Compared toMT alone and given conventional threshold values, MitraClip can be considered a costeffective procedure. The cost-effectiveness of MitraClip is in line or superior to the one of other nonpharmaceutical strategies for heart failure
Granulocyte colony-stimulating factor for stem cell mobilisation in acute myocardial infarction: a randomised controlled trial
No full textBackground To determine whether granulocyte colony-stimulating factor (G-CSF) improves clinical outcomes after large ST-elevation myocardial infarction (STEMI) when administered early in patients with left ventricular (LV) dysfunction after successful percutaneous coronary intervention (PCI). Methods STEM-AMI OUTCOME was designed as a prospective, multicentre, nationwide, randomised, open-label, phase III trial (ClinicalTrials.gov ID: NCT01969890) to demonstrate the efficacy and safety of early G-CSF administration in reducing 2-year cardiac mortality and morbidity in patients with STEMI with LV ejection fraction ≤45% after PCI. The primary outcome was a composite of all-cause death, recurrence of myocardial infarction and hospitalisation for heart failure. Due to low recruitment and event rates, the study was discontinued and did not achieve adequate statistical power to verify the hypothesis. Results Patients were randomly allocated to G-CSF (n=260) or standard of care (SOC; n=261). No difference was found in the composite primary outcome between study groups (HR 1.20; 95% CI 0.63 to 2.28). The 2-year mortality was 2.31% in the G-CSF and 2.68% in the control group (HR 0.88; 95% CI 0.29 to 2.60). Adverse events did not differ between the G-CSF (n=65) and SOC groups (n=58; OR 1.17; 95% CI 0.78 to 1.75). In post hoc analyses on the intervention group, we observed a trend towards fewer composite primary outcomes in patients with low bone marrow (BM) cell mobilisation (n=108) versus those with high mobilisation (n=152, with peak leucocyte count >50×109/L; HR 2.86; 95% CI 0.96 to 8.56). Primary outcomes were lower in patients with severe LV systolic dysfunction at discharge treated with G-CSF than in controls (interaction β±SE, −0.08±0.04; p=0.034). Conclusions Although inconclusive, this is the largest trial in the field of cell-based cardiac repair after STEMI providing evidence of the tolerability and long-term safety of G-CSF treatment. The results prompt further studies to understand which patient can benefit most from BM cell mobilisation
Il peso delle disparità socio-economiche nell’eziologia, gestione e outcome dei pazienti con scompenso cardiaco: il registro Global Congestive Heart Failure (G-CHF)
Full text linkClinical features, and in-hospital and 1-year mortalities of patients with acute heart failure and severe renal dysfunction. Data from the Italian Registry IN-HF Outcome
No full textChronic renal dysfunction (RD) frequently coexists with heart failure (HF) and influences outcome. Patients with acute HF (AHF) and severe RD are frequently excluded in the trials. We characterized these subjects and assessed incidence and predictors of in-hospital and one-year mortalities
Prognostic Impact of Diabetes and Prediabetes on Survival Outcomes in Patients With Chronic Heart Failure: A Post-Hoc Analysis of the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) Trial
Full text linkThe independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre-DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre-DM on survival outcomes in the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial
Antipsicotici di seconda generazione ed eventi cardio-metabolici: analisi real-world e costi assistenziali. [Second-generation antipsychotics and cardio-metabolic events: real-world analysis and healthcare costs]
No full textScopo. L’analisi ha individuato e caratterizzato i pazienti incidenti al trattamento con antipsicotici di seconda generazione (SGA) in Italia e ha valutato lo sviluppo di eventi cardio-metabolici (CM) nei 3 anni successivi all’inizio della terapia con SGA e i costi assistenziali annuali a carico del Servizio Sanitario Nazionale (SSN). Metodi. Dal database di Fondazione ReS (Ricerca e Salute), sono state individuate tutte le persone adulte in terapia con SGA nel 2015 (erogazione indice). Nei 2 anni di pregresso sono state definite l’incidenza al trattamento e la presenza/assenza di patologie CM o condizioni predisponenti tali malattie, individuando 3 coorti: A) con disordini di entrambi i tipi; B) solo con condizioni predisponenti; C) senza disturbi CM o predisponenti. Alle coorti B e C sono stati appaiati pazienti con stesse condizioni cliniche ma non in terapia con SGA. All’interno delle coorti e dei relativi appaiamenti, sono state ricercate le patologie CM/condizioni predisponenti verificatisi (casi) nei 3 anni successivi l’erogazione indice e confrontate per probabilità di sviluppo con i gruppi appaiati (controlli), tramite un’analisi di sopravvivenza all’evento (curve Kaplan-Meier). Risultati. Tra più di 4 milioni di adulti dal database ReS, 12.128 sono risultati incidenti a SGA (2,8 x1000), di cui 2732 nella coorte A (22,5%) con età mediana 80 (69;87), 1492 nella coorte B (12,3%) con età mediana 77 (63;85), 7904 nella coorte C (65,2%) con età mediana 60 (37;84). Erano soprattutto donne e l’incidenza di trattamento aumentava con l’età. Le probabilità di sviluppo di eventi CM sono state: 15,8% e 13,3% tra casi e controlli della coorte B e 7,5% e 5,1% tra casi e controlli della coorte C. Le probabilità di sviluppo di condizioni predisponenti sono state del 10% e 7% tra casi e controlli della coorte C. Tutte le differenze sono risultate significative (p<0,01). Il costo medio integrato era simile tra caso e controllo e influenzato soprattutto dalle ospedalizzazioni. Discussione e conclusione. Lo sviluppo di eventi CM/condizioni predisponenti nei pazienti anziani rappresenta un problema clinico e di sostenibilità del SSN. È necessario favorire l’appropriata scelta terapeutica e il monitoraggio del paziente trattato con antipsicotici.Objective: This analysis has identified and characterized new users of second-generation antipsychotics (SGA) in Italy and has assessed the occurrence of cardio-metabolic (CM) events over 3 years after the SGA starting therapy and the annual healthcare costs, in the perspective of the Italian National Health System (INHS). Methods: Starting from the Fondazione ReS (Ricerca e Salute)'s database, adults treated with SGA in 2015 (index supply) were selected. By analyzing 2 previous years, treatment incidence and presence/absence of CM diseases or predisposing conditions (PC) to these events were defined and 3 cohorts were identified: A) with CM or predisposing conditions, B) only with PC, C) without neither CM nor predisposing conditions. Cohorts B and C were paired with patients with the same clinical profiles but without any SGA supply. Into cohorts and related paired groups, CM diseases/predisposing conditions occurred (cases) during the 3-year follow-up after the index supply were searched. Cases were compared with related control groups in terms of probability of CM disease/predisposing conditions occurrence (survival analysis to the event - Kaplan-Meier curves). Results: Among more than 4 million adults, 12,218 were incident to SGA (2.8 x1,000): 2,732 composed cohort A (22.5%) with median age 80 (69;87), 1,492 cohort B (12.3%) with median age 77 (63;85), 7,904 cohort C (65.2%) with median age 60 (37;84). They were mostly females. The treatment incidence increased with age. The probabilities of CM events were: 15.8% and 13.3% among cases and controls of cohort B, and 7.5% and 5.1% among cases and controls of cohort C. Probabilities of predisposing conditions occurrence were 10% and 7.0% among cases and controls of cohort C. All differences were significant (p<0.01). The mean integrated healthcare cost was similar between case and control. Hospitalizations accounted for the most expenditure. Discussion and conclusion: CM events or predisposing conditions occurrence in the elderly is both a clinical and an economic issue for the INHS. The proper therapeutic choice and monitoring of patient treated with antipsychotics must be encouraged
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