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.

Rationale and design of lifestyle intervention using mobile technology in patients with high cardiovascular risk: A pragmatic randomized clinical trial.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality throughout the world and contributes a considerable burden to healthcare costs. Primary prevention strategies, particularly adopting healthy lifestyle habits, have great potential to reduce the risk of CVD. Patient compliance remains the major cause of the failure of primary prevention strategies. Telehealth interventions and gamification through mobile applications can increase adherence and reduce healthcare costs. The primary objective of this study is to compare the effect of lifestyle intervention using mobile technology plus usual care with usual care alone in patients with a high CVD risk.

Incremental value of live/real time three-dimensional transesophageal echocardiography over the two-dimensional technique in the assessment of primary cardiac malignant fibrous histiocytoma.

We describe a case of primary cardiac malignant fibrous histiocytoma where live/real time three-dimensional transesophageal echocardiography added incremental value to the two-dimensional modalities. Specifically, the three-dimensional technique allowed us to delineate the true extent and infiltration of the tumor, to identify characteristics of the tumor mass suggestive of its malignant nature, and to quantitatively assess the total tumor burden.

Assessment of right ventricular endocardial dysfunction in mild-to-moderate mitral stenosis patients using velocity vector imaging.

PURPOSE: Right ventricular (RV) function plays an important role in the development of clinical symptoms, exercise capacity, prognosis, and survival in patients with mitral stenosis (MS). The purpose of this study was to evaluate global and regional RV systolic functions using a novel technique, VVI, in mild-to-moderate MS patients without clinical symptoms of heart failure. METHODS: The study population consisted of 60 patients (mean age 51.7 ± 11.6 years; 85% female) with isolated rheumatic mitral valve stenosis and 40 age- and sex-matched control subjects (mean age 49.1 ± 10.5 years; 76.7% female). Conventional echocardiography, tissue Doppler imaging (TDI), strain (S), and strain rate (SRs) analysis were performed in all patients. RESULTS: Transmitral mean pressure gradient was 6.1 ± 3.0 mmHg and mean mitral valve area was 1.41 ± 0.31 cm(2) in patients with MS. TDI systolic velocity was significantly lower in MS patients compared to control subjects (0.13 ± 0.03 m/sec vs. 0.17 ± 0.03 m/sec; P < 0.0001). RV-isovolumic acceleration was reduced in MS patients (3.75 ± 1.09 m/sec(2) vs. 4.62 ± 1.0 m/sec(2) ; P = 0.006). RV-myocardial performance index was significantly increased in patients with MS (0.75 ± 0.05 in MS and 0.29 ± 0.04 in controls; P < 0.0001) revealing impaired RV systolic and diastolic function. The mean longitudinal peak systolic S and SR were significantly reduced in patients with MS (P < 0.0001). CONCLUSION: Our data revealed that RV systolic performance is reduced in patients with mild-to-moderate MS.

Assessment of right atrial pressure using echocardiography and correlation with catheterization.

PURPOSE: Right ventricular systolic pressure is crucial for both treatment and prognosis of cardiovascular and pulmonary diseases. The proper measurement of right ventricular systolic pressure depends on an accurate estimation of right atrial pressure (RAP). There is no standard method for estimating RAP noninvasively. The purpose of this study was to compare different noninvasive methods, namely, inferior vena cava (IVC) size and inspiratory collapse, tissue Doppler derived E/E' (TV E/E') for estimating RAP, and their correlation with catheter-based measurements in patients with mitral valve stenosis with atrial fibrillation (AF) or normal sinus rhythm (NSR). METHODS: The study group consisted of 39 patients (13 men, mean age 58.9 ± 11.8 years) with rheumatic mitral valve stenosis. We performed cardiac catheterization and transthoracic echocardiography on all patients. RESULTS: Mean RAP measured by catheterization was 9.7 ± 3.8 mmHg. No correlation was found between RAP and TV E/E' ratio, but there was a significant correlation between RAP and IVC diameter (r = 0.51, p < 0.05). Seventeen patients (43.6%) were in AF and 22 patients (56.4%) were in NSR. There was no correlation between TV E/E' ratio and RAP in patients with AF and in patients with NSR. RAP was correlated with collapsibility index in patients with AF (r = 0.56, p < 0.05). RAP was significantly correlated with IVC diameter (r = 0.62, p < 0.005) and collapsibility index (r = 0.49, p < 0.05) in patients with NSR. CONCLUSIONS: The combination of IVC diameter and collapsibility index is a simple a semiquantitative approach that might provide a better estimation of RAP.

Transesophageal echocardiographic assessment of a floating thrombus located in the ascending aorta.

Transesophageal echocardiography (TEE) has become a unique imaging technique that provides improved visualization of aorta because of its proximity to the esophagus. It is a reliable method for the diagnosis of thoracic aorta diseases and detection of protruding atheromas or thrombi as sources of systemic emboli. We report a case in which TEE revealed a floating aortic thrombus located in the ascending aorta in a patient with chronic renal failure.