Cost-of-disease of Heart Failure in Turkey: A Delphi Panel-based Analysis of Direct and Indirect Costs.

Background: Heart failure (HF) is considered a significant public health issue with a substantial and growing epidemiologic and economic burden in relation to longer life expectancy and aging global population. Aims: To determine cost-of-disease of heart failure (HF) in Turkey from the payer perspective. Study Design: Cross-sectional cost of disease study. Methods: In this cost-of-disease study, annual direct and indirect costs of management of HF were determined based on epidemiological, clinical and lost productivity inputs provided by a Delphi panel consisted of 11 experts in HF with respect to ejection fraction (EF) status (HF patients with reduced EF (HFrEF), mid-range EF (HFmrEF) and preserved EF (HFpEF)) and New York Heart Association (NYHA) classification. Direct medical costs included cost items on outpatient management, inpatient management, medications, and non-pharmaceutical treatments. Indirect cost was calculated based on the lost productivity due to absenteeism and presenteeism. Results: 51.4%, 19.5%, and 29.1% of the patients were estimated to be HFrEF, HFmrEF, and HFpEF patients, respectively. The total annual direct medical cost per patient was $887 and non-pharmaceutical treatments ($373, 42.1%) were the major direct cost driver. Since an estimated nationwide number of HF patients is 1,128,000 in 2021, the total annual national economic burden of HF is estimated to be $1 billion in 2021. The direct medical cost was higher in patients with HFrEF than in those with HFmrEF or HFpEF ($1,147 vs. $555 and $649, respectively). Average indirect cost per patient was calculated to be $3,386 and was similar across HFrEF, HFmrEF and HFpEF groups, but increased with advanced NYHA stage. Conclusion: Our findings confirm the substantial economic burden of HF in terms of both direct and indirect costs and indicate that the non-pharmaceutical cost is the major direct medical cost driver in HF management, regardless of the EF status of HF patients.

Diagnosis and management of acute heart failure.

Acute heart failure (AHF) is a life threatening clinical syndrome with a progressively increasing incidence in general population. Turkey is a country with a high cardiovascular mortality and recent national statistics show that the population structure has turned to an 'aged' population.As a consequence, AHF has become one of the main reasons of admission to cardiology clinics. This consensus report summarizes clinical and prognostic classification of AHF, its worldwide and national epidemiology, diagnostic work-up, principles of approach in emergency department,intensive care unit and ward, treatment in different clinical scenarios and approach in special conditions and how to plan hospital discharge.

Assessment of shoulder pain and shoulder disability in patients with implantable cardioverter-defibrillator.

PURPOSE: Shoulder pain and disability is a common but overlooked disorder in patients with implantable cardioverter-defibrillators (ICD). We aimed to assess chronic shoulder pain and disability in patients with ICD. METHODS: Two hundred fifty-four patients (mean age, 66 ± 12 years; 156 men) with ICD were included in the study. The Shoulder Pain and Disability Index (SPADI) was used for assessment of shoulder pain and disability. RESULTS: Of the patients, 131 (52 %) have shoulder pain and disability. The total mean SPADI score in patients with shoulder pain and disability was 33 ± 18 and was significantly higher than in patients without shoulder pain and disability (11 ± 2; p < 0.001). Patients with three-lead ICD have significantly higher SPADI scores than patients with single-lead ICD (p < 0.001). Number of leads correlated with pain score (p = 0.001, r = 0.253), disability score (p = 0.006, r = 0.174) and total SPADI score (p = 0.001, r = 0.213). In multivariate analysis, significant associates of shoulder pain and disability were evaluated, adjusting for age, sex, body mass index, procedure time, implantation time interval, limitation of shoulder activity and number of leads. Number of leads was the only predictor of shoulder pain and disability (OR 0.518, 95 % CI, 0.372-0.721; p < 0.001). CONCLUSIONS: Patients with ICD implantation frequently have chronic shoulder pain and disability. Patients with three leads suffer more shoulder pain and disability.

[Cardiovascular risk assessment and risk stratification- guided therapy: predict, prevent and individualize]. / Kardiyovasküler risk belirlenmesi ve tabakalandirilmasinin kilavuzluguyla yapilan tedavi yaklasimi: Öngör, önle ve bireysellestir.

Modern concept in primary prevention of cardiovascular diseases (CVD) entails assessing the person's global risk and making the right management in accordance with these results. Correspondingly, 3 steps recommended for the prevention of CVD under risk guidance are: (a) risk assessment via a proper system like Framingham Risk Score, SCORE, QRISK, PROCAM; (b) decision-making in the proper management in terms of informing the patient about lifestyle changes that he or she can cope and drug selection; and (c) evaluation of treatment decision in terms of cost effectiveness. Although, a significant decline is observed in CVD morbidity and mortality, particularly in the western countries, we still are trying to approach to competent quality measures about management under CV risk guidance. This review summarizes the main challenges regarding risk stratification-guided management strategy in primary prevention of CVD.

Comparison of gated SPECT, echocardiography and cardiac magnetic resonance imaging for the assessment of left ventricular ejection fraction and volumes.

BACKGROUND: Left ventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume (ESV) can be determined non-invasively by two-dimensional enchocardiography (ECHO), gated sinle photon emission computed tomography (GSPECT) and cardiac magnetic resonance imaging (CMRI). This study was designed to analyze the concordance between LVEF, EDV and ESV values derived from ECHO, GSPECT and CMRI. METHODS: ECHO, GSPECT and CMRI were performed in a group of 21 patients with suspected coronary artery disease. LVEF, EDV and ESV values were calculated. RESULTS: The mean LVEF measured with GSPECT, ECHO and CMRI were 55.9+/-17.8%, 55.7+/-16.4% and 56.4+/-15.7%, respectively. The mean EDV measured with GSPECT, ECHO and CMRI were 109.2+/-42.45 mL, 127.5+/-42.2 mL, 91.1+/-38.0 mL, respectively. The mean ESV measured with GSPECT, ECHO and CMRI were 54.2+/-41.2 mL, 59.9+/-37.6 mL and 41.8+/-26.9 mL, respectively. The results of linear regression analysis showed very good correlation between LVEF and ESV values derived from GSPECT, ECHO adn CMRI (r=0.91, r=0.92, r=0.97 for LVEF and r=0.86, r=0-91, r=0.91 for ESV, P<0.01). Good correlations were found between EDV values obtained from GSPECT, ECHO and CMRI (r=0.71, r=0.68, r=0.73, P<0.01). Agreement between these techniques in LVEF values was also good, but not in LV volumes, according to Bland-Altman plots. CONCLUSIONS: This study showed good overall correlations between LVEF, EDV and ESV values derived from GSPECT, ECHO and CMRI. LVEF obtained from any of these three imaging modalities could be used interchangeably. However, care should be taken in comparing LV volumes.

Assessment of left ventricular function and volumes for patients with dilated cardiomyopathy using gated myocardial perfusion SPECT and comparison with echocardiography.

AIM: Left ventricular function, volumes and regional wall motion provide valuable diagnostic information and are of long-term prognostic importance in patients with dilated cardiomyopathy (DCM). This study was designed to compare the effectiveness of two-dimensional echocardiography and gated single photon emission computed tomography (SPECT) to evaluate these parameters in patients with DCM. METHODS: Gated SPECT and two-dimensional echocardiography were performed in 45 patients with DCM, and in 10 normal subjects as the control group. Patients were divided into two groups according to the aetiology of DCM: group I, ischaemic DCM (n=30); group II, non-ischaemic DCM (n=15). All patients and the control group underwent resting myocardial gated SPECT, 45 min after injection of 555 MBq of Tc-methoxyisobutyl-isonitrile (Tc-MIBI). Gated SPECT data, including left ventricular volumes and left ventricular ejection fraction (LVEF), were processed using an automated algorithm. Simpson's method was used to evaluate these parameters. Regional wall motion was evaluated using both modalities and scored using a 16-segment model with a five-point scoring system. Perfusion defects were expressed as a percentage of the whole myocardium planimetered by a bull's-eye polar map of composite non-gated SPECT. Myocardial perfusion was scored using a 16-segment model with a four-point scoring system. RESULTS: Mean perfusion defects and perfusion defect scores were 25+/-13% and 1.12+/-0.36 in group I and 4+/-8% and 0.76+/-0.26 in group II (P<0.01). The overall agreement between the two imaging modalities for the assessment of regional wall motion was 57% (403/720 segments: 269/480 segments in group I and 134/240 segments in group II). With gated SPECT, LVEF was 27+/-9%, the end-diastolic volume (EDV) was 212+/-71 ml and the end-systolic volume (ESV) was 160+/-67 ml. With echocardiography, these values were 29+/-8%, 197+/-56 ml and 139+/-47 ml, respectively. The correlation between gated SPECT and two-dimensional echocardiography was good (r=0.72, P<0.01) for the assessment of LVEF. The correlation was also good for EDV and ESV, but with wider limits of agreement (r= 0.71, P<0.01 and r=0.71, P<0.01, respectively) and with significantly higher values with gated SPECT (P<0.01). For patients with a perfusion defect of <20% or low myocardial perfusion scores, a higher correlation was found between the two methods for the assessment of LVEF, EDV and ESV. On the other hand, the correlation was lower for the assessment of wall motion. CONCLUSIONS: Gated SPECT and two-dimensional echocardiography correlate well for the assessment of left ventricular function and volumes. Gated SPECT has the advantage of providing information about left ventricular function, dimensions and perfusion.