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Inpatient and outpatient costs in patients with coronary artery disease and mental disorders: a systematic review

May 8, 2015 Comments off

Inpatient and outpatient costs in patients with coronary artery disease and mental disorders: a systematic review
Source: BioPsychoSocial Medicine

Background
To systematically review in- and outpatient costs in patients with coronary artery disease (CAD) and comorbid mental disorders.

Methods
A comprehensive database search was conducted for studies investigating persons with CAD and comorbid mental disorders (Medline, EMBASE, PsycINFO, Psyndex, EconLit, IBSS). All studies were included which allowed a comparison of in- and outpatient health care costs (assessed either monetarily or in terms of health care utilization) of CAD patients with comorbid mental disorders (mood, anxiety, alcohol, eating, somatoform and personality disorders) and those without. Random effects meta-analyses were conducted and results reported using forest plots.

Results
The literature search resulted in 7,275 potentially relevant studies, of which 52 met inclusion criteria. Hospital readmission rates were increased in CAD patients with any mental disorder (pooled standardized mean difference (SMD) = 0.34 [0.17;0.51]). Results for depression, anxiety and posttraumatic stress disorder pointed in the same direction with heterogeneous SMDs on a primary study level ranging from −0.44 to 1.26. Length of hospital stay was not increased in anxiety and any mental disorder, while studies on depression reported heterogeneous SMDs ranging from −0.08 to 0.82. Most studies reported increased overall and outpatient costs for patients with comorbid mental disorders. Results for invasive procedures were non-significant respectively inconclusive.

Conclusions
Comorbid mental disorders in CAD patients are associated with an increased healthcare utilization in terms of higher hospital readmission rates and increased overall and outpatient health care costs. From a health care point of view, it is requisite to improve the diagnosis and treatment of comorbid mental disorders in patients with CAD to minimize incremental costs.

Genetically Determined Height and Coronary Artery Disease

April 10, 2015 Comments off

Genetically Determined Height and Coronary Artery Disease
Source: New England Journal of Medicine

BACKGROUND
The nature and underlying mechanisms of an inverse association between adult height and the risk of coronary artery disease (CAD) are unclear.

METHODS
We used a genetic approach to investigate the association between height and CAD, using 180 height-associated genetic variants. We tested the association between a change in genetically determined height of 1 SD (6.5 cm) with the risk of CAD in 65,066 cases and 128,383 controls. Using individual-level genotype data from 18,249 persons, we also examined the risk of CAD associated with the presence of various numbers of height-associated alleles. To identify putative mechanisms, we analyzed whether genetically determined height was associated with known cardiovascular risk factors and performed a pathway analysis of the height-associated genes.

RESULTS
We observed a relative increase of 13.5% (95% confidence interval [CI], 5.4 to 22.1; P<0.001) in the risk of CAD per 1-SD decrease in genetically determined height. There was a graded relationship between the presence of an increased number of height-raising variants and a reduced risk of CAD (odds ratio for height quar-tile 4 versus quartile 1, 0.74; 95% CI, 0.68 to 0.84; P<0.001). Of the 12 risk factors that we studied, we observed significant associations only with levels of low-density lipoprotein cholesterol and triglycerides (accounting for approximately 30% of the association). We identified several overlapping pathways involving genes associated with both development and atherosclerosis.

CONCLUSIONS
There is a primary association between a genetically determined shorter height and an increased risk of CAD, a link that is partly explained by the association between shorter height and an adverse lipid profile. Shared biologic processes that determine achieved height and the development of atherosclerosis may explain some of the association. (Funded by the British Heart Foundation and others.)

Prescription Cholesterol-lowering Medication Use in Adults Aged 40 and Over: United States, 2003–2012

February 23, 2015 Comments off

Prescription Cholesterol-lowering Medication Use in Adults Aged 40 and Over: United States, 2003–2012
Source: National Center for Health Statistics

Key findings

Data from the National Health and Nutrition Examination Survey

  • During 2003–2012, the percentage of adults aged 40 and over using a cholesterol-lowering medication in the past 30 days increased from 20% to 28%.
  • The use of statins increased from 18% to 26%. By 2011–2012, 93% of adults using a cholesterol-lowering medication used a statin.
  • Cholesterol-lowering medication use increased with age, from 17% of adults aged 40–59 to 48% of adults aged 75 and over.
  • About 71% of adults with cardiovascular disease and 54% of adults with hypercholesterolemia used a cholesterol-lowering medication.
  • Adults aged 40–64 with health insurance were more likely than those without health insurance to use a cholesterol-lowering medication.

Women’s Health Issues: Special Collection on Women’s Heart Health

February 3, 2015 Comments off

Special Collection on Women’s Heart Health
Source: Women’s Health Issues

For American Heart Month 2015, the editorial team at Women’s Health Issues has assembled a special collection of research on women’s cardiovascular health published in the journal since mid-2011, following the release of updated American Heart Association guidelines on the prevention of cardiovascular disease in women. The articles address healthcare services for women at risk for cardiovascular disease; social determinants of health; and physical activity in specific populations of women.

These articles will be accessible for free during the month of February 2015 so that they are available to a wider interested audience.

The Emerging Crisis: Noncommunicable Diseases

January 15, 2015 Comments off

The Emerging Crisis: Noncommunicable Diseases
Source: Council on Foreign Relations

The gravest health threats facing low- and middle-income countries are not the plagues, parasites, and blights that dominate the news cycle and international relief efforts. They are the everyday diseases the international community understands and could address, but fails to take action against.

Once thought to be challenges for affluent countries alone, cardiovascular diseases, cancer, diabetes, and other noncommunicable diseases (NCDs) have emerged as the leading cause of death and disability in developing countries. In 2013, these diseases killed eight million people before their sixtieth birthdays in these countries. The chronic nature of NCDs means patients are sick and suffer longer and require more medical care. The resulting economic costs are high and escalating. Unless urgent action is taken, this emerging crisis will worsen in low- and middle-income countries and become harder to address.

Medical Cost Offsets from Prescription Drug Utilization Among Medicare Beneficiaries

October 27, 2014 Comments off

Medical Cost Offsets from Prescription Drug Utilization Among Medicare Beneficiaries (PDF)
Source: Journal of Managed Care & Specialty Pharmacy

This brief commentary extends earlier work on the value of adherence to derive medical cost offset estimates from prescription drug utilization. Among seniors with chronic vascular disease, 1% increases in condition- specific medication use were associated with significant ( P < 0.001) reductions in gross nonpharmacy medical costs in the amounts of 0.63% for dyslipidemia, 0.77% for congestive heart failure, 0.83% for diabetes, and 1.17% for hypertension.

Mild hypertension in people at low risk

September 22, 2014 Comments off

Mild hypertension in people at low risk
Source: British Medical Journal

Summary box

  • Clinical context—Up to 40% of adults worldwide have hypertension, complications of which may account for up to 9.4 million deaths annually from cardiovascular disease
  • Diagnostic change—Recommendations for drug treatment have decreased from diastolic pressure of >115 mm Hg to ≥140/90 mm Hg. A new category, prehypertension (120/80-139/89 mm Hg), has also been introduced
  • Rationale for change—Patients with even mildly raised blood pressure may have increased cardiovascular risk
  • Leap of faith—Lowering threshold blood pressures will lead to increased diagnosis and treatment, which will decrease mortality
  • Impact on prevalence—22% of adults worldwide have mild hypertension (systolic pressure 140-159 mm Hg) and 13.5% have a systolic pressure ≥160 mm Hg
  • Evidence of overdiagnosis—Use of a uniform threshold (140 mm Hg) to mark hypertension risk ignores evidence that risk varies by individual and includes many people who will not benefit from drug treatment
  • Harms from overdiagnosis—Studies suggest over half of people with mild hypertension are treated with drugs even though this approach has not been proved to decrease mortality or morbidity. Overemphasis on drug treatment risks adverse effects, such as increased risk of falls, and misses opportunities to modify individual lifestyle choices and tackle lifestyle factors at a public health level
  • Limitations of evidence — Lack of randomised trials that use hard outcomes and compare drugs with lifestyle interventions and placebo in patients with mild hypertension
  • Conclusion—Lowering definitions of hypertension has led to identification and drug treatment of larger populations of patients despite lack of evidence that drugs reduce morbidity or mortality
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