Cardiology News / Recent Literature Review / First Quarter 2016
ACC 65th Annual Session: Chicago, 2-4/4/2016
HRS 37th Annual Meeting: San Francisco, 4-7/5/16
CardioStim/Europace: Nice, 8-11/6/2016
Euro PCR: Paris, 17-20/5/2016
ESC Meeting: Rome, 27-31/8/2016
HCS Panhellenic Congress: Athens, 20-22/10/2016
TCT Conference: Washington, DC, 29/10-2/11/2016
AHA Scientific Sessions: New Orleans, 12-16/11/2016
Exercise-Based Cardiac Rehabilitation Reduces the Risk of Cardiovascular (CV) Mortality and Hospital Admission and Improves Quality of Life in Patients With Coronary Heart Disease
Meta-analyses of exercise-based cardiac rehabilitation (CR) studies (n=63) comprising 14,486 participants with median follow-up of 12 months indicated that CR led to a reduction in CV mortality (relative risk: 0.74) and the risk of hospital admissions (relative risk: 0.82). There was no significant effect on total mortality, myocardial infarction, or revascularization. The majority of studies (14 of 20) showed higher levels of health-related quality of life in 1 or more domains following exercise-based CR compared with control subjects (Anderson L et al, J Am Coll Cardiol 2016;67:1-12).
Coronary CT Angiography (CCTA), Applied Early in Suspected Acute Coronary Syndrome (ACS), is Safe and Associated with Less Outpatient Testing and Lower Costs. However, in the Era of hs-Troponins, it does not Identify more Patients with Significant CAD Requiring Coronary Revascularization, nor does it Shorten Hospital Stay or Allow for More Immediate Discharge from The Emergency Department (ED)
Among 500 patients (aged 54 ± 10 years, 47% women) with symptoms suggestive of an ACS at the ED, there was no difference in the primary endpoint (22 - 9% patients underwent coronary revascularization within 30 days in the CCTA group and 17 - 7% in the standard care group; p= NS). Discharge from the ED was not more frequent after CCTA (65% vs 59%, p= NS), and length of stay was similar (6.3 h in both groups; p= NS). The CCTA group had lower direct medical costs (€337 vs. €511, p< 0.01) and less outpatient testing after the index ED visit (10 - 4% vs 26 - 10%, p< 0.01). There was no difference in incidence of undetected ACS (Dedic A et al, J Am Coll Cardiol 2016; 67:16-26).
Cost-Effectiveness of Transcatheter Aortic Valve Implantation (TAVI) with a Self-Expanding Prosthesis vs Surgical Aortic Valve Replacement (AVR): TAVI in Patients at High Risk for Complications with AVR Provides Important Incremental Health Benefits at Reasonable Incremental Costs and is an Acceptable Value for the U.S. Health Care System
Relative to AVR, TAVI reduced initial length of stay an average of 4.4 days, decreased the need for rehabilitation services at discharge, and resulted in superior 1-month quality of life. Index admission and projected lifetime costs were higher with TAVI than with AVR (differences $11,260 and $17,849 per patient, respectively), whereas TAVI was projected to provide a lifetime gain of 0.32 quality-adjusted life-years (QALY; 0.41 LY) with 3% discounting. Lifetime incremental cost-effectiveness ratios were $55,090 per QALY gained and $43,114 per LY gained. N.B.: mean procedure costs: $37,920 for TAVI & $14,258 for AVR (Reynolds MR et al, J Am Coll Cardiol 2016;67:29-38)... (excerpt)
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