scholarly journals Effects of adherence to pharmacological secondary prevention after acute myocardial infarction on health care costs – an analysis of real-world data

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Florian Kirsch ◽  
Christian Becker ◽  
Christoph Kurz ◽  
Lars Schwettmann ◽  
Anja Schramm
Keyword(s):  
Myocardial Infarction ◽  
Health Care ◽  
Acute Myocardial Infarction ◽  
Mixed Model ◽  
Health Care Expenditure ◽  
Health Care Expenditures ◽  
Third Party ◽  
Negative Deviation ◽  
Individual Effects ◽  
The Mean

Abstract Background Acute myocardial infarction (AMI), a major source of morbidity and mortality, is also associated with excess costs. Findings from previous studies were divergent regarding the effect on health care expenditure of adherence to guideline-recommended medication. However, gender-specific medication effectiveness, correlating the effectiveness of concomitant medication and variation in adherence over time, has not yet been considered. Methods We aim to measure the effect of adherence on health care expenditures stratified by gender from a third-party payer’s perspective in a sample of statutory insured Disease Management Program participants over a follow-up period of 3-years. In 3627 AMI patients, the proportion of days covered (PDC) for four guideline-recommended medications was calculated. A generalized additive mixed model was used, taking into account inter-individual effects (mean PDC rate) and intra-individual effects (deviation from the mean PDC rate). Results Regarding inter-individual effects, for both sexes only anti-platelet agents had a significant negative influence indicating that higher mean PDC rates lead to higher costs. With respect to intra-individual effects, for females higher deviations from the mean PDC rate for angiotensin-converting enzyme (ACE) inhibitors, anti-platelet agents, and statins were associated with higher costs. Furthermore, for males, an increasing positive deviation from the PDC mean increases costs for β-blockers and a negative deviation decreases costs. For anti-platelet agents, an increasing deviation from the PDC-mean slightly increases costs. Conclusion Positive and negative deviation from the mean PDC rate, independent of how high the mean was, usually negatively affect health care expenditures. Therefore, continuity in intake of guideline-recommended medication is important to save costs.

scholarly journals Effects of Adherence to Pharmacological Secondary Prevention after Acute Myocardial Infarction on Health Care Costs – An Analysis of Real-World Data

2020 ◽  
Author(s):  
Florian Kirsch ◽  
Christian Becker ◽  
Christoph Kurz ◽  
Lars Schwettmann ◽  
Anja Schramm
Keyword(s):  
Myocardial Infarction ◽  
Health Care ◽  
Acute Myocardial Infarction ◽  
Mixed Model ◽  
Health Care Expenditure ◽  
Health Care Expenditures ◽  
Individual Effect ◽  
Negative Deviation ◽  
Individual Effects ◽  
The Mean

Abstract Background: Acute myocardial infarction (AMI), a major source of morbidity and mortality, is also associated with excess costs. Findings from previous studies were divergent regarding the effect of adherence to guideline-recommended medication on health care expenditure. However, gender-specific medication effectiveness, correlating effectiveness of concomitant medication and variation in adherence over time were not yet considered. Methods: We aim to measure this from a third-party payer’s perspective in a sample of statutory insured Disease Management Program participants over a follow-up period of 3-years. In 3,627 AMI patients, the proportion of days covered (PDC) for four guideline-recommended medications were calculated. A generalized additive mixed model was used, taking into account inter-individual effects (mean PDC-rate) and intra-individual effects (deviation from the mean PDC-rate). Results: For the inter-individual effect, only anti-platelet agents had a significant negative influence, higher mean PDC rates lead to higher costs in both sexes. For the intra-individual effect, a higher deviation from the mean PDC-rate for ACE-inhibitors, anti-platelet agents, and statins was associated with higher costs in females. Further, in males, for β-blockers an increasing positive deviation from the PDC-mean increases costs and a negative deviation decreases costs. For anti-platelet agents an increasing deviation from the PDC-mean slightly increases costs.Conclusion: Positive and negative deviation from the mean PDC-rate, independent of how high the mean was, usually negatively affect health care expenditures. Therefore, continuity in intake of guideline recommended medication is important to save costs.

Influence of Acute Myocardial Infarction and rt-PA Therapy on Circulating Fibrinogen

1993 ◽  
Vol 69 (04) ◽  
pp. 321-327 ◽  
Author(s):  
E Seifried ◽  
M Oethinger ◽  
P Tanswell ◽  
E Hoegee-de Nobel ◽  
W Nieuwenhuizen
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Thrombolytic Agent ◽  
Degradation Products ◽  
Maximum Plasma ◽  
Normal Range ◽  
Fibrinogen Degradation Products ◽  
Fibrin Degradation Products ◽  
Rebound Phenomenon ◽  
The Mean

SummaryIn 12 patients treated with 100 mg rt-PA/3 h for acute myocardial infarction (AMI), serial fibrinogen levels were measured with the Clauss clotting rate assay (“functional fibrinogen”) and with a new enzyme immunoassay for immunologically intact fibrinogen (“intact fibrinogen”). Levels of functional and “intact fibrinogen” were strikingly different: functional levels were higher at baseline; showed a more pronounced breakdown during rt-PA therapy; and a rebound phenomenon which was not seen for “intact fibrinogen”. The ratio of functional to “intact fibrinogen” was calculated for each individual patient and each time point. The mean ratio (n = 12) was 1.6 at baseline, 1.0 at 90 min, and increased markedly between 8 and 24 h to a maximum of 2.1 (p <0.01), indicating that functionality of circulating fibrinogen changes during AMI and subsequent thrombolytic therapy. The increased ratio of functional to “intact fibrinogen” seems to reflect a more functional fibrinogen at baseline and following rt-PA infusion. This is in keeping with data that the relative amount of fast clotting “intact HMW fibrinogen” of total fibrinogen is increased in initial phase of AMI. The data suggest that about 20% of HMW fibrinogen are converted to partly degraded fibrinogen during rt-PA infusion. The rebound phenomenon exhibited by functional fibrinogen may result from newly synthesized fibrinogen with a high proportion of HMW fibrinogen with its known higher degree of phosphorylation. Fibrinogen- and fibrin degradation products were within normal range at baseline. Upon infusion of the thrombolytic agent, maximum median levels of 5.88 μg/ml and 5.28 μg/ml, respectively, were measured at 90 min. Maximum plasma fibrinogen degradation products represented only 4% of lost “intact fibrinogen”, but they correlatedstrongly and linearly with the extent of “intact fibrinogen” degradation (r = 0.82, p <0.01). In contrast, no correlation was seen between breakdown of “intact fibrinogen” and corresponding levels of fibrin degradation products. We conclude from our data that the ratio of functional to immunologically “intact fibrinogen” may serve as an important index for functionality of fibrinogen and select patients at high risk for early reocclusion. Only a small proportion of degraded functional and “intact fibrinogen”, respectively, is recovered as fibrinogen degradation products. There seems to be a strong correlation between the degree of elevation of fibrinogen degradation products and the intensity of the systemic lytic state, i.e. fibrinogen degradation.

The Quantitation of Platelet Aggregation Induced by Four Compounds: A Study in Relation to Myocardial Infarction

1966 ◽  
Vol 16 (03/04) ◽  
pp. 752-767 ◽  
Author(s):  
J. R O’Brien ◽  
F. C Path ◽  
Joan B. Heywood ◽  
J. A Heady
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Platelet Aggregation ◽  
Platelet Rich Plasma ◽  
Myocardial Infarct ◽  
Control Groups ◽  
The Mean ◽  
Platelet Shape

SummaryMethods for measuring and comparing day to day differences in the response of platelet aggregation in platelet-rich plasma to added ADP, 5-H.T., adrenaline and collagen are reported. Platelet aggregation induced by ADP, 5-H.T. and adrenaline was studied in patients with acute myocardial infarction and in others 3 months to 5 years after an infarct; some were receiving anti-coagulants and others not: these three groups were compared with three control groups. The mean platelet shape was rounder and the response to ADP and to 5-H.T. and one parameter of the response to adrenaline was significantly greater in all groups of patients with myocardial infarct taken together than in the controls. The platelet-rich plasma from patients with recent infarction were most responsive to ADP and 5-H.T. immediately after the infarct. Anti-coagulants had no effect on these tests. However, there was wide variation within the individuals and much overlap between groups, and these tests can only reliably distinguish between groups and not between individuals. The significance of these findings is discussed.

Trajectory of prehospital delay in patients with acute myocardial infarction in the Japanese health care system

2006 ◽  
Vol 107 (2) ◽  
pp. 188-193 ◽  
Author(s):  
Yoshimi Fukuoka ◽  
Kathleen Dracup ◽  
Fumio Kobayashi ◽  
Erika Sivarajan Froelicher ◽  
Sally H. Rankin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Health Care ◽  
Acute Myocardial Infarction ◽  
Health Care System ◽  
Prehospital Delay ◽  
Care System

SGLT2 inhibitors: A revolution in therapeutics of a major Non-Communicable Disease

2021 ◽  
pp. 1-3
Author(s):  
Muhammad Sami Khan
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Health Care Providers ◽  
Communicable Disease ◽  
Health Care Expenditure ◽  
Health Care Expenditures ◽  
Sglt2 Inhibitors ◽  
Care Providers ◽  
Cardiovascular Outcome Trials ◽  
Non Communicable Disease

Pakistan is facing an exorbitant burden of Non-communicable diseases among which Cardiovascular diseases are the most prominent which has not only caused mortality but also posed a big threat on weakened economy and health care system of the country. Amidst of this growing crisis, Sodium glucose co-transporter 2 (SGLT2) inhibitors emerge as a ray of hope by reducing simultaneously the complication and health care expenditure associated with the management of this major mortality-bringing Non-communicable disease. SGLT2 inhibitors, including Dapagliflozin and Empagliflozin, are evidence-based standardized novel anti-diabetic agents tested in cardiovascular outcome trials namely DAPA-HF and EMPEROR-Reduced, when added to standard care in heart failure patients with reduced ejection fraction, provides breakthrough heart failure outcomes and also addresses massive health care expenditures. This novel finding provides an impetus to promote its beneficial effects among health care providers and early implementation. Continuous....

scholarly journals Early, Subacute Coronary Stent Thrombosis: A Complication of COVID-19 Infection

2021 ◽  
pp. 1-4
Author(s):  
Sadeq Tabatabai ◽  
Nooshin Bazargani ◽  
Kamaleldin Al-Tahmody ◽  
Jasem Mohammed Alhashmi
Keyword(s):  
Myocardial Infarction ◽  
Health Care ◽  
Acute Myocardial Infarction ◽  
Stent Thrombosis ◽  
Coronary Angioplasty ◽  
Anterior Wall ◽  
Coronary Stent ◽  
Antithrombotic Agents ◽  
Health Care Burden ◽  
Primary Coronary Angioplasty

Soon after it was discovered in Wuhan, China, in December 2019, coronavirus disease 2019 (COVID-19) blow-out very fast and became a pandemic. The usual presentation is respiratory tract infection, but cardiovascular system involvement is sometimes fatal and also a serious personal and health care burden. We report a case of a 57-year-old man who was admitted with anterior wall acute myocardial infarction secondary to early coronary stent thrombosis and associated with COVID-19 infection. He was managed with primary coronary angioplasty and discharged home. Procoagulant and hypercoagulability status associated with severe acute respiratory syndrome coronavirus 2 infection is the most likely culprit. Choosing aggressive antithrombotic agents after coronary angioplasty to prevent stent thrombosis during the COVID-19 pandemic may be the answer but could be challenging.

scholarly journals Does better availability mean better accessibility? Spatial inequalities in the care of acute myocardial infarction in Hungary

2020 ◽  
Vol 69 (4) ◽  
pp. 401-418
Author(s):  
Annamária Uzzoli ◽  
Zoltán Egri ◽  
Dániel Szilágyi ◽  
Viktor Pál
Keyword(s):  
Myocardial Infarction ◽  
Health Care ◽  
Acute Myocardial Infarction ◽  
Statistical Analysis ◽  
Health Literacy ◽  
Access To Health Care ◽  
Health Care Services ◽  
Care Services ◽  
Spatial Inequalities ◽  
Access To Health

The availability of health care services is an important issue, however, improving availability of health care services does not necessarily mean better accessibility for everybody. The main aim of this study is to find out how better availability in the care of acute myocardial infarction vary with accessibility of patients’ geographical location within Hungary. We applied statistical analysis and interview techniques to unfold the role of spatiality in the conditions of access to health care. Results of statistical analysis indicate significant health inequalities in Hungary. Decreasing national mortality rates of acute myocardial infarction, has been coupled by increasing spatial inequalities within the country especially at micro-regional level. According to in-depth interviews with local health care stakeholders we defined factors that support access to health care as well as important barriers. The supporting factors are related to the improvement of availability (i.e. infrastructural developments), while geographical distance, lack of material and human resources, or low level of health literacy proved to be the most relevant barriers. Main conclusion is that barriers to accessibility and availability are not only spatial but are also based on individual stages of acute myocardial infarction care. The development of cardiac catheter centres in Hungary has improved the short-term chances of infarction survival, but long-term survival chances have worsened in recent years due to deficiencies in rehabilitation care as well as low level of health literacy.

Comparison of Health Care Expenditures Among U.S. Older Adults With Pain Who Reported Frequent Exercise Versus Nonfrequent Exercise

2021 ◽  
pp. 1-9
Author(s):  
David R. Axon ◽  
Jonathan Chien ◽  
Hanh Dinh
Keyword(s):  
Health Care ◽  
Medical Expenditure Panel Survey ◽  
Survey Design ◽  
Health Care Expenditure ◽  
Prescription Medication ◽  
Health Care Expenditures ◽  
Cross Sectional Study ◽  
Medical Expenditure ◽  
Cross Sectional ◽  
Nationally Representative

This cross-sectional study included a nationally representative sample of U.S. adults aged ≥50 years with self-reported pain in the past 4 weeks from the 2018 Medical Expenditure Panel Survey. Adjusted linear regression analyses accounted for the complex survey design and assessed differences in several types of annual health care expenditures between individuals who reported frequent exercise (≥30 min of moderate–vigorous intensity physical activity ≥5 times per week) and those who did not. Approximately 23,940,144 of 56,979,267 older U.S. adults with pain reported frequent exercise. In adjusted analyses, individuals who reported frequent exercise had 15% lower annual prescription medication expenditures compared with those who did not report frequent exercise (p = .007). There were no statistical differences between frequent exercise status for other health care expenditure types (p > .05). In conclusion, adjusted annual prescription medication expenditures were 15% lower among older U.S. adults with pain who reported frequent exercise versus those who did not.

scholarly journals When analyses are invalidated by erroneous assumptions

2005 ◽  
Vol 21 (3) ◽  
pp. 414-416
Author(s):  
Christian Juhl Terkelsen ◽  
Jens Flensted Lassen ◽  
Bjarne Linde Nørgaard ◽  
Torsten Toftegaard Nielsen ◽  
Henning Rud Andersen
Keyword(s):  
Public Health ◽  
Myocardial Infarction ◽  
Health Care ◽  
Acute Myocardial Infarction ◽  
Cost Effectiveness ◽  
Technology Assessment ◽  
Health Assessment ◽  
Master Of Public Health

In a recent publication in the “International Journal of Technology Assessment in Health Care” (7), Kildemoes and Kristiansen claim to address “Cost-effectiveness of interventions to reduce the thrombolytic delay for acute myocardial infarction.” Their study is based on a “Master of Public Health Assessment” thesis published by Kildemoes in the year 2001 (6). Three years ago, the author was informed that several of her assumptions were incorrect. In this letter, we will address six of the erroneous assumptions made by Kildemoes and Kristiansen.

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