PMD37 The Cost-Effectiveness Analysis of CT Coronary Angiography Versus Myocardial Spect for the Diagnosis of Ischemic Heart Disease in Patients with Chest Pain

Objectives:Obesity and dyslipidemia are risk factors for ischemic heart disease, and prevention and treatment in primary care can reduce these risks. The objective of this cost-effectiveness analysis was to compare the costs and effects (in terms of life years gained) of providing nutritional counseling by a general practitioner (GP) or a dietician.Methods:A total of 60 GPs, who accepted to participate, were randomized either to give nutritional counseling or to refer patients to a dietician for counseling. The life years gained was estimated using a Cox regression model. Costs were estimated on the basis of registered use of time (dieticians) or agreed salaries (GPs).Results:The effect of nutritional counseling comparing GPs and dieticians is greatest when counseling is performed by a GP—0.0919 years versus 0.0274 years. These effects appear to be moderate, but they are significant. It is also proven that the GP group was the most cost-effective—the cost of gaining 1 extra life year was estimated to be 8,213 DKK compared with the dietician group, for which the incremental cost-effectiveness ratio was estimated to be 59,987 DKK.Conclusions:The effects were moderate, but other studies of other patient groups and interventions report effects within the same magnitude. The GP group was the most cost-effective, but it must be concluded that both counseling strategies were relatively cost-effective. Even though the cost of gaining an extra life year was estimated to be 59,987 DKK in the dietician group, this might be an acceptable price.

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Societal costs of non-cardiac chest pain compared with ischemic heart disease - a longitudinal study

BMC Health Services Research ◽

10.1186/1472-6963-13-403 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 27

Author(s):

Ghassan Mourad ◽

Jenny Alwin ◽

Anna Strömberg ◽

Tiny Jaarsma

Keyword(s):

Heart Disease ◽

Longitudinal Study ◽

Chest Pain ◽

Ischemic Heart Disease ◽

Ischemic Heart ◽

Societal Costs

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Abstract 342: Impact Of System And Physician Factors On The Diagnostic Yield Of Coronary Angiography In Stable Ischemic Heart Disease: A Population Based Study

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.342 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Harindra C Wijeysundera ◽

Feng Qiu ◽

Maria C Bennell ◽

Madhu K Natarajan ◽

Warren J Cantor ◽

...

Keyword(s):

Coronary Artery Disease ◽

Heart Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Ischemic Heart Disease ◽

Diagnostic Yield ◽

Obstructive Coronary Artery Disease ◽

Ischemic Heart ◽

Patient Factors ◽

Artery Disease

Background: Wide variation exists in the diagnostic yield of coronary angiography in stable ischemic heart disease (IHD). Previous work has primarily focused on patient factors for this variation. We sought to understand if system and physician factors, specifically hospital and physician type, as well as physician self-referral, have incremental impacts on the yield of coronary angiography, above and beyond that of patient factors alone. Methods: All patients who underwent a diagnostic coronary angiogram for possible stable IHD, at the 18 cardiac centers in Ontario, Canada were identified from October 1st, 2008 to September 30th, 2011. Obstructive coronary artery disease was defined as stenosis greater than 70% in the main coronary arteries or greater than 50% in the left main artery. Physicians were classified as either invasive or interventional. Hospitals were categorized into cath only, stand-alone PCI and full service centers. Multi-variable hierarchical logistic models were developed to identify system and physician level predictors of obstructive coronary artery disease, having adjusted for patient factors. Results: Our cohort consisted of 60,986 patients who underwent a diagnostic angiogram for possible stable IHD, of which 33,483 had obstructive coronary artery disease (54.9%), ranging from 41.0% to 70.2% across centers. Self-referral rates varied from 4.8% to 74.6%. Fewer self-referral patients (52.5%) had obstructive coronary artery disease compared to non-self-referral patients (56.5%), with an odds ratio (OR) of 0.89 (95% CI 0.85-0.93;p <0.001), after accounting for patient factors. Angiograms performed by interventional physicians had a higher likelihood of showing obstructive coronary artery disease (60.1% vs. 50.8%; OR 1.22; 95% CI 1.17-1.28; p<0.001). Fewer angiograms at cath only centers showed obstructive disease (45.0%) compared to full service centers (58.1%); this was of borderline significance (OR 0.59; 95% CI 0.34-1.00; p=0.05). Conclusion: Physician and system factors are important predictors of the diagnostic yield of coronary angiography in stable IHD, even after accounting for patient characteristics. Further study into the drivers of how these physician and system factors impact diagnostic yield is an important focus for quality improvement.

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A study on the clinical profile and risk factors of ischemic heart disease in women

Medpusle International Journal of Medicine ◽

10.26611/102119310 ◽

2021 ◽

Vol 19 (3) ◽

pp. 130-132

Author(s):

Sarath Kumar Reddy B ◽

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Chest Pain ◽

Ischemic Heart Disease ◽

Stable Angina ◽

Heart Diseases ◽

Chronic Stable Angina ◽

Clinical Profile ◽

Ischemic Heart ◽

Ischemic Heart Diseases

Background: Ischemic heart disease (IHD) is one of the principle causes of morbidity and of mortality in women1. Ischemic heart disease may manifest clinically as either chronic stable angina or acute coronary syndrome2 (ACS). Traditional risk factors (hypertension, diabetes, etc.) contribute to the development of IHD in both women and men. Some risk factors are unique to women (e.g., pregnancy-related complications, menopause), which cause increased mortality in women Aim: To study the risk factors and clinical profile of ischemic heart disease in women. Materials And Methods: Hospital-based prospective, cross-sectional study done in 50 patients with ischemic heart disease. Patients with a history of Chest pain suggestive of ischemic heart diseases and Electrocardiogram and cardiac biomarkers suggestive of ischemic heart disease were included in the study. Results: Maximum incidence of ischemic heart diseases is seen in the 6th decade. Mean age is 58.92 + 2.8years. 64%of the patients presented with chest pain, and 36% patients presented without any chest pain. After chest pain, the most common symptom was palpitations, seen in 56% patients, followed by sweating (44%). 30% presented to the medical facility within 3hours. 88% were diagnosed with acute coronary syndrome, and 12% were diagnosed with chronic stable angina. Women specific risk factors include the pregnancy-related complications seen in 10% patients, menopause attained in 86% patients, PCOS seen in 08% patients, use of oral contraceptive pills noticed in 08% patients, Other risk factors identified were hypothyroidism in 16% patients, connective tissue disorders like rheumatoid arthritis seen in 12% of the patients. Conclusion: Awareness regarding atypical symptoms as well as other symptoms of IHD should be created among women to avoid delayed complications. Simple lifestyle modifications like physical activity, diet modifications, etc., will reduce the number of women at risk for IHD.

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