Men with erectile dysfunction (ED) should be screened for cardiovascular risk factors - Cost-benefit considerations in Swiss men.

Background: Current evidence indicates that erectile dysfunction (ED) is an independent risk factor for future cardiovascular events. This study aimed to estimate the cost-effectiveness of screening and subsequent preventive treatment for cardiovascular risk factors among men newly diagnosed with ED from the Swiss healthcare system perspective. Methods: Based on known data on ED and cardiovascular disease (CVD) prevalence and incidence costs and effects of a screening intervention for cardiovascular risk including corresponding cardiovascular prevention in men with ED were calculated for the Swiss population over a period of 10 years. Results: Screening and cardiovascular prevention over a period of 10 years in Swiss men with ED of all seriousness degrees, moderate and severe ED only, or severe ED only can probably avoid 41,564, 35,627, or 21,206 acute CVD events, respectively. Number needed to screen (NNS) to prevent one acute CVD event is 30, 23, and 10, respectively. Costs for the screening intervention are expected to be covered at the seventh, the fifth, and the first year, respectively. Conclusion: Screening and intervention for cardiovascular risk factors in men suffering from ED is a cost-effective tool not only to strengthen prevention and early detection of cardiovascular diseases but also to avoid future cardiovascular events.

Initial results of a computerized screening alert for abdominal aortic aneurysm in patients undergoing vascular assessment.

BACKGROUND: Although routine ultrasound screening for abdominal aortic aneurysm (AAA) reduces mortality in subjects at risk, it is often omitted in clinical practice. Because computerized alerts may systematically identify subjects at risk of AAA, we hypothesized that such alerts would encourage physicians to perform an ultrasound screening test. PATIENTS AND METHODS: We designed and implemented a computer alert system into the patient database of our vascular outpatient clinic at a tertiary referral hospital in Switzerland. An electronic alert was issued instantaneously each time a physician accessed non-invasive arterial work-up data from a male subject aged ≥ 60 years. The physician was forced to acknowledge the alert and could then order or withhold ultrasound screening. RESULTS: From 2008 to 2012, alerts were issued for 1673 subjects. Following the alert, ultrasound screening was withheld in 1107 (65.6 %) subjects, and it was performed in 576 (34.4 %) of whom 155 were excluded for numerous reasons. Among 421 screened subjects, aortic diameters were < 25 mm in 353 (84 %), 25 to 29 mm in 20 (5 %), 30 to 54 mm in 40 (10 %), and ≥ 55 mm in 8 (2 %). CONCLUSIONS: The AAA prevalence among screened subjects with computerized alerts was high, confirming the necessity to routinely screen male subjects ≥ 60 years undergoing non-invasive arterial work-up. However, physician compliance with alerts was poor since only one quarter of subjects with alerts underwent screening. Further quality improvement initiatives are urgently required to facilitate routine AAA screening among subjects at high risk.

Stroke, coronary and peripheral artery disease survey on antithrombotic treatment (START IT).

QUESTIONS UNDER STUDY: To determine the perception of primary care physicians regarding the risk of subsequent atherothrombotic events in patients with established cardiovascular (CV) disease, and to correlate this perception with documented antithrombotic therapy. METHODS: In a cross-sectional study of the general practice population in Switzerland, 381 primary care physicians screened 127 040 outpatients during 15 consecutive workdays in 2006. Perception of subsequent atherothrombotic events in patients with established CV disease was assessed using a tick box questionnaire allowing choices between low, moderate, high or very high risk. Logistic regression models were used to determine the relationship between risk perception and antithrombotic treatment. RESULTS: Overall, 13 057 patients (10.4%) were identified as having established CV disease and 48.8% of those were estimated to be at high to very high risk for subsequent atherothrombotic events. Estimated higher risk for subsequent atherothrombotic events was associated with a shift from aspirin monotherapy to clopidogrel, vitamin K antagonist or aspirin plus clopidogrel (p <0.001 for trend). Clopidogrel (12.7% vs 6.8%, p <0.001), vitamin K antagonist (24.5% vs 15.6%, p <0.001) or aspirin plus clopidogrel (10.2% vs 4.2%, p <0.001) were prescribed in patients estimated to be at high to very high risk more often than in those at low to moderate risk. CONCLUSIONS: Perception of primary care physicians regarding risk of subsequent atherothrombotic events varies in patients with CV disease, and as a result antithrombotic therapy is altered in patients with anticipated high to very high risk even though robust evidence and clear guidelines are lacking.