Costs analysis from a randomized comparison of immediate versus delayed angiography in patients successfully resuscitated after out-of-hospital cardiac arrest

Abstract Background In out-of-hospital cardiac arrest (OHCA) patients without ST-segment elevation, immediate coronary angiography did not improve clinical outcomes when compared to delayed angiography in the Coronary Angiography after Cardiac Arrest (COACT) trial (1,2). Whether one of the two strategies has benefits in terms of healthcare resource use and costs is currently unknown. We assess the healthcare resource use and costs in patients with OHCA. Methods 521 patients were eligible for a cost consequence analysis. Detailed healthcare resource use and cost-prices were collected from the initial hospital episode and compared between both groups. A generalized model (GLM) with a log link function and a gamma distribution was performed. Generic quality of life was measured with the RAND36 and collected at 12 months follow-up. Results Overall total mean costs were similar between both groups (EUR 33575±19612 vs EUR 33880±21044, P=0.86). GLM: (β 0.991 (95% CI 0.894–1.099), P=0.86. Mean procedural costs (CAG and/or PCI, coronary artery bypass graft) were higher in the immediate angiography group (EUR 4384±3447 vs EUR 3028±4220, P<0.001). Costs concerning Intensive Care Unit and ward stay did not show any significant difference. The median for the RAND-36 questionnaire physical component score was 49.2 in the immediate angiography group and 50.4 in the delayed group, P=0.57. Conclusions The mean total costs between OHCA patients randomized to an immediate angiography or a delayed invasive strategy were similar. With respect to the higher invasive procedure costs in the immediate group, a strategy awaiting neurological recovery followed by coronary angiography and planned revascularization may be considered. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Supported by unrestricted research grants from the Netherlands Heart Institute, Biotronik, and AstraZeneca.

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Women have a worse prognosis and undergo fewer coronary angiographies after out-of-hospital cardiac arrest than men

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872617696368 ◽

2017 ◽

Vol 7 (5) ◽

pp. 414-422 ◽

Cited By ~ 12

Author(s):

Matilde Winther-Jensen ◽

Christian Hassager ◽

Jesper Kjaergaard ◽

John Bro-Jeppesen ◽

Jakob H Thomsen ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Cardiac Arrest ◽

Coronary Artery ◽

Coronary Angiography ◽

Functional Status ◽

Artery Bypass ◽

Coronary Intervention ◽

Bypass Grafting ◽

Percutaneous Coronary ◽

Hospital Cardiac Arrest

Background: Out-of-hospital cardiac arrest is more often reported in men than in women. Objectives: We aimed to assess sex-related differences in post-resuscitation care; especially with regards to coronary angiography, percutaneous coronary intervention, mortality and functional status after out-of-hospital cardiac arrest. Methods: We included 704 consecutive adult out-of-hospital cardiac arrest-patients with cardiac aetiology in the Copenhagen area from 2007–2011. Utstein guidelines were used for the pre-hospital data. Vital status and pre-arrest comorbidities were acquired from Danish registries and review of patient charts. Logistic regression was used to assess differences in functional status and use of post-resuscitation care. Cox regression was used to assess differences in 30-day mortality. We used ‘smcfcs’ and ‘mice’ imputation to handle missing data. Results: Female sex was associated with higher 30-day mortality after adjusting for age and comorbidity (hazard ratio (HR): 1.42, confidence interval (CI): 1.13–1.79, p<0.01), this was not significant when adjusting for primary rhythm (HR: 1.12, CI: 0.88–1.42, p=0.37). Women less frequently received coronary angiography <24 h in multiple regression after out-of-hospital cardiac arrest (odds ratio (OR)CAG=0.55, CI: 0.31–0.97, p=0.041), however no difference in percutaneous coronary intervention was found (ORPCI=0.55, CI: 0.23–1.36, p=0.19). Coronary artery bypass grafting was less often performed in women (ORCABG: 0.10, CI: 0.01–0.78, p=0.03). There was no difference in functional status at discharge between men and women ( p=1). Conclusion: Female sex was not significantly associated with higher mortality when adjusting for confounders. Women less often underwent coronary angiography and coronary artery bypass grafting, but it is not clear whether this difference can be explained by other factors, or an actual under-treatment in women.

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Health Related Quality of Life Among Coronary Artery Bypass Graft Patient Attended at Combined Military Hospital, Dhaka

Anwer Khan Modern Medical College Journal ◽

10.3329/akmmcj.v4i2.16918 ◽

2013 ◽

Vol 4 (2) ◽

pp. 10-17

Author(s):

SM Nurul Irfan ◽

Md. Mahbubur Rahaman ◽

Abu Noman ◽

Sangita Mithun

Keyword(s):

Quality Of Life ◽

Physical Functioning ◽

Artery Bypass ◽

Bypass Graft ◽

Physical Component Score ◽

Military Hospital ◽

Monthly Income ◽

Sf 36 ◽

Significant Difference

This descriptive type of cross sectional study was carried out among purposively selected 90 coronary artery bypass graft operated patients attended at cardiovascular surgery out patient department of combined military hospital, Dhaka from 01 March 2012 to 30 June 2012 with the objective to assess the quality of life by using the RAND Medical Outcomes Short Form 36 (SF- 36) questionnaire. The population studied had a mean age of 54.60 years with 92.2% were male and 7.8% were female. Most of the respondents were retired (43.3%) followed by service personnel (38.9%). Regarding educational qualification, most of them were between class VIII to SSC and 95.6% were Muslim. The mean monthly income of the respondents was Tk. 18127.78. The findings showed that post CABG respondents possessed a good level of QOL with an average score of 86.0921. The mental components score (87.8571) was found to be higher than physical component score (84.9153). It was found that the association between age and physical functioning domain of physical component was statistically significant (r= -.189*, p<0.05) and association between all other domains (role physical, bodily pain, general health, vitality, social functioning, role emotional and mental health) were statistically not significant. The study also revealed a negative correlation of total quality of life with age but positive correlation with other socio demographic characteristics (level of income, education and occupation) though all of the relations were statistically not significant. No statistically significant difference revealed with the different domains of quality of life and socio demographic characteristics. In regards to the monthly income, highest score noted in Tk. 10000-30000 income groups in all the domains. Respondents' occupation showed significant difference with the general health domain (F= 3.456, p <0.05) and physical component summary (F= 2.969, p <0.05) of the SF- 36 items. The education level showed significant difference with the physical functioning of physical component domain (F= 2.675, p <0.05). The findings showed that the highest score was for HSC education in both the components of quality of life. The post CABG respondents possessed a good level of QOL with good mental components score than physical component score. It is also revealed from the study that with increasing age the physical functioning of the patient decreases. From the study it depicts that higher education, better occupation and good monthly income of the respondents have better quality of life out come than that of others. Study on larger sample size may be carried out for more accurate results on quality of life after CABG operation. Anwer Khan Modern Medical College Journal Vol. 4, No. 2: July 2013, Pages 10-17 DOI: http://dx.doi.org/10.3329/akmmcj.v4i2.16918

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Type D personality in Greek employees: Somatization, cardiovascular events and healthcare resource use

PsycEXTRA Dataset ◽

10.1037/e604062012-370 ◽

2012 ◽

Author(s):

Athanasios Lagoudis ◽

Christine Varvara ◽

Panagiotis Stafylas ◽

Stavros Gousopoulos

Keyword(s):

Resource Use ◽

Cardiovascular Events ◽

Healthcare Resource ◽

Type D Personality ◽

Healthcare Resource Use ◽

Type D

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Quantification of Coronary Artery Stenosis with 16-Slice MSCT in Patients before CABG Surgery: Comparison to Standard Invasive Coronary Angiography

The Heart Surgery Forum ◽

10.1532/hsf98.20041144 ◽

2005 ◽

Vol 8 (1) ◽

pp. 42 ◽

Cited By ~ 12

Author(s):

C. Probst ◽

A. Kovacs ◽

C. Schmitz ◽

W. Schiller ◽

H. Schild ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Angiography ◽

Coronary Arteries ◽

Artery Bypass ◽

Invasive Coronary Angiography ◽

Bypass Graft ◽

Heart Association ◽

Artery Stenosis ◽

Vessel Disease ◽

Selective Coronary Angiography

Objective: Invasive, selective coronary angiography is the gold standard for evaluation of coronary artery disease (CAD) and degree of stenosis. The purpose of this study was to compare 3-dimensional (3D) reconstructed 16-slice multislice computed tomographic (MSCT) angiography and selective coronary angiography in patients before elective coronary artery bypass graft (CABG) procedure. Methods: Sixteen-slice MSCT scans (Philips Mx8000 IDT) were performed in 50 patients (42 male/8 female; mean age, 64.44 8.66 years) scheduled for elective CABG procedure. Scans were retrospectively electrocardiogram-gated 3D reconstructed. The images of the coronary arteries were evaluated for stenosis by 2 independent radiologists. The results were compared with the coronary angiography findings using the American Heart Association segmental classification for coronary arteries. Results: Four patients (8%) were excluded for technical reasons. Thirty-eight patients (82.6%) had 3-vessel disease, 4 (8.7 %) had 2-vessel disease, and 4 (8.7%) had an isolated left anterior descending artery stenosis. In the proximal segments all stenoses >50% (56/56) were detected by MSCT; medial segment sensitivity was 97% (73/75), specificity 90.3%; distal segment sensitivity was 90.7% (59/65), specificity 77%. Conclusion: Accurate quantification of coronary stenosis greater than 50% in the proximal and medial segments is possible with high sensitivity and specificity using the new generation of 16-slice MSCTs. There is still a tendency to overestimate stenosis in the distal segments. MSCT seems to be an excellent diagnostic tool for screening patients with possible CAD.

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Predictors of poor health and functional recovery following road trauma: protocol of a British Columbian inception cohort study

BMJ Open ◽

10.1136/bmjopen-2021-049623 ◽

2021 ◽

Vol 11 (4) ◽

pp. e049623

Author(s):

Leona K Shum ◽

Herbert Chan ◽

Shannon Erdelyi ◽

Lulu X Pei ◽

Jeffrey R Brubacher

Keyword(s):

Resource Use ◽

Healthcare Resource ◽

Healthcare Providers ◽

Healthcare Resource Use ◽

Physical And Mental Health ◽

Inception Cohort ◽

Policy Makers ◽

Productivity Costs ◽

Poor Outcome ◽

Lost Productivity

IntroductionRoad trauma (RT) is a major public health problem affecting physical and mental health, and may result in prolonged absenteeism from work or study. It is important for healthcare providers to know which RT survivors are at risk of a poor outcome, and policy-makers should know the associated costs. Unfortunately, outcome after RT is poorly understood, especially for RT survivors who are treated and released from an emergency department (ED) without the need for hospital admission. Currently, there is almost no research on risk factors for a poor outcome among RT survivors. This study will use current Canadian data to address these knowledge gaps.Methods and analysisWe will follow an inception cohort of 1500 RT survivors (16 years and older) who visited a participating ED within 24 hours of the accident. Baseline interviews determine pre-existing health and functional status, and other potential risk factors for a poor outcome. Follow-up interviews at 2, 4, 6, and 12 months (key stages of recovery) use standardised health-related quality of life tools to determine physical and mental health outcome, functional recovery, and healthcare resource use and lost productivity costs.Ethics and disseminationThe Road Trauma Outcome Study is approved by our institutional Research Ethics Board. This study aims to provide healthcare providers with knowledge on how quickly RT survivors recover from their injuries and who may be more likely to have a poor outcome. We anticipate that this information will be used to improve management of all road users following RT. Healthcare resource use and lost productivity costs will be collected to provide a better cost estimate of the effects of RT. This information can be used by policy-makers to make informed decisions on RT prevention programmes.

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Admission biomarkers among patients with acute myocardial-infarction related cardiogenic shock with or without out-of-hospital cardiac arrest

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.090 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

M Thoegersen ◽

M Frydland ◽

O Helgestad ◽

LO Jensen ◽

J Josiassen ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Arrest ◽

Coronary Angiography ◽

Cardiogenic Shock ◽

Plasma Concentrations ◽

Endothelial Damage ◽

Soluble Thrombomodulin ◽

Catheterization Laboratory ◽

Hospital Cardiac Arrest

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Lundbeck Foundation OnBehalf Critical Cardiac Care Research Group Background Approximately half of all patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) present with out-of-hospital cardiac arrest (OHCA). Cardiogenic shock due to OHCA is caused by abrupt cessation of circulation, whereas AMICS without OHCA is due to cardiac failure with low cardiac output. Thus, there may also be differences between the two conditions in terms of blood borne biomarkers. Purpose To explore the potential differences in the admission plasma concentrations of biomarkers reflecting tissue perfusion (lactate), neuroendocrine response (mid-regional proadrenomedullin [MRproADM], Copeptin, pro-atrial natriuretic peptide [proANP]), endothelial damage (Syndecan-1, soluble thrombomodulin [sTM]), inflammation (soluble suppression of tumorigenicity 2 [sST2]) and kidney injury (neutrophil gelatinase-associated lipocalin [NGAL]), in patients with AMICS presenting with or without OHCA. Method Consecutive patients admitted for acute coronary angiography due to suspected ST-elevation myocardial infarction (STEMI) were enrolled during a 1-year period. A total of 2,713 patients were screened. In the present study 86 patients with confirmed STEMI and CS at admission were included. Results Patients with OHCA (had significantly higher median admission concentrations of Lactate (6,9 mmol/L vs. 3.4 mmol/L p <0.001), NGAL (220 ng/ml vs 150 ng/ml p = 0.046), sTM (10 ng/ml vs. 8.0 ng/ml p = 0.026) and Syndecan-1 (160 ng/ml vs. 120 ng/ml p= 0.015) and significantly lower concentrations of MR-proADM (0.85 nmol/L vs. 1.6 nmol/L p <0.001) and sST2 (39 ng/ml vs. 62 ng/ml p < 0.001). After adjusting for age, sex, and time from symptom onset to coronary angiography, lactate (p = 0.008), NGAL (p = 0.03) and sTM (p = 0.011) were still significantly higher in patients presenting with OHCA while sST2 was still significantly lower (p = 0.029). There was very little difference in 30-day mortality between the OHCA and non-OHCA groups (OHCA 37% vs. non-OHCA 38%). Conclusion Patients with STEMI and CS at admission with or without concomitant OHCA had similar 30-day mortality but differed in terms of Lactate, NGAL, sTM and sST2 levels at the time of admission to catheterization laboratory. These findings propose that non-OHCA and OHCA patients with CS could be considered as two individual clinical entities. Abstract Figure. Level of biomarkers OHCA vs. non-OHCA

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