RESUMO
INTRODUCTION: Cardiology conferences represent a major avenue for learning, career advancement, and professional networking. Yet, costs of attending these conferences represent a major barrier, particularly for trainees and participants from low-middle-income countries (LMICs). Our study aimed to analyze the registration fees of major cardiology conferences worldwide. METHODS: We included conferences organized by international cardiovascular societies and those representing global regions. We did not include individual national or institutional conferences due to inability to systematically identify them. We collected 2024 registration fees from official conference websites, taking 2023 or 2022 fees if unavailable, and categorized them according to career stage and society membership status. Where specified, we chose 'early-bird' fees. All fees were converted to US dollars according to currency exchange rates per the International Monetary Fund on December 4, 2023, or if unavailable, per the last reported US Treasury Data. Other data collected included host country, virtual option availability, and LMIC discounts. RESULTS: 30 (65.2â¯%) conferences provided discounts for medical students, regardless of membership status, while 1 (2.2â¯%) provided discounts only for student-members. 36 (78.2â¯%) conferences offered discounts for residents/fellows, while 2 (4.3â¯%) offered discounts only for resident/fellow-members. Median fees for students and residents/fellows with membership were $255 and $287 (in US dollars), respectively while median fees for non-members were $303.5 and $397, respectively. 31 (67.4â¯%) conferences provided discounts for staff- members. Median fees for staff were $701 and $800 for members and non-members, respectively. Only 12 (26.1â¯%) conferences mentioned a virtual component, with 11 offering discounted registration compared with in-person rates. 7 (15.2â¯%) conferences had special in-person fees for LMIC-based registrants. 5 offered the same discounted rate regardless of training stage, while 2 offered additional discounts for trainees. CONCLUSION: We found that conference registration costs were substantial, including for trainees, with only a minority of conferences providing discounted rates for LMICs. Professional societies must reduce registration costs, potentially by implementing a tiered system based on training stage and country of origin. Further, to augment LMIC participation, dedicated scholarships and mentorship programs for LMIC-based registrants are needed.
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Cardiologia , Congressos como Assunto , Humanos , Cardiologia/educação , Cardiologia/economia , Honorários e Preços , Sociedades Médicas , Países em DesenvolvimentoRESUMO
BACKGROUND. The energy demand of interventional imaging systems has historically been estimated using manufacturer-provided specifications rather than directly measured. OBJECTIVE. The purpose of this study was to investigate the energy consumption of interventional imaging systems and estimate potential savings in the carbon emissions and electricity costs of such systems through hypothetical operational adjustments. METHODS. An interventional radiology suite, neurointerventional suite, radiology fluoroscopy unit, two cardiology laboratories, and two urology fluoroscopy units were equipped with power sensors. Power measurement logs were extracted for a single 4-week period for each radiology and cardiology system (all between June 1, 2022, and November 28, 2022) and for the 2-week period from July 31, 2023, to August 13, 2023, for each urology system. Power statuses, procedure time stamps, and fluoroscopy times were extracted from various sources. System activity was divided into off, idle (no patient in room), active (patient in room for procedure), and net-imaging (active fluoroscopic image acquisition) states. Projected annual energy consumption was calculated. Potential annual savings in carbon emissions and electricity costs through hypothetical operational adjustments were estimated using published values for Switzerland. RESULTS. Across the seven systems, the mean power draw was 0.3-1.1, 0.7-7.4, 0.9-7.6, and 1.9-12.5 kW in the off, idle, active, and net-imaging states, respectively. Across systems, the off state, in comparison with the idle state, showed a decrease in the mean power draw of 0.2-6.9 kW (relative decrease, 22.2-93.2%). The systems had a combined projected annual energy consumption of 115,684 kWh (range, 3646-26,576 kWh per system). The systems' combined projected energy consumption occurring outside the net-imaging state accounted for 93.3% (107,978/115,684 kWh) of projected total energy consumption (range, 89.2-99.4% per system). A hypothetical operational adjustment whereby all systems would be switched from the idle state to the off state overnight and on weekends (versus being operated in idle mode 24 hours a day, 7 days a week) would yield the following potential annual savings: for energy consumption, 144,640 kWh; for carbon emissions, 18.6 metric tons of CO2 equivalent; and for electricity costs, US$37,896. CONCLUSION. Interventional imaging systems are energy intensive, having high consumption outside of image acquisition periods. CLINICAL IMPACT. Strategic operational adjustments (e.g., powering down idle systems) can substantially decrease the carbon emissions and electricity costs of interventional imaging systems.
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Radiografia Intervencionista , Humanos , Radiografia Intervencionista/economia , Fluoroscopia/economia , Urologia/economia , Cardiologia/economia , Eletricidade , Pegada de CarbonoAssuntos
Academias e Institutos , Pesquisa Biomédica , Cardiologia , Doenças Cardiovasculares , Academias e Institutos/economia , Academias e Institutos/tendências , Pesquisa Biomédica/economia , Pesquisa Biomédica/tendências , Cardiologia/economia , Cardiologia/tendências , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/terapia , Comportamento Cooperativo , Difusão de Inovações , Previsões , Humanos , Cultura Organizacional , Parcerias Público-Privadas , Apoio à Pesquisa como Assunto , Espanha , Local de TrabalhoRESUMO
Each guideline recommendation from the American Heart Association and the American College of Cardiology includes an indication of the level of supporting evidence and the associated strength of recommendation with "IA" recommendations representing those with the highest quality supporting evidence and the least amount of uncertainty for benefit. In this analysis, study type and funding sources were systematically tabulated across these IA guideline recommendations over the past 5 years. Nearly half of studies supporting IA guideline recommendations were randomized controlled trials (45%). Overall, about one third of studies supporting IA recommendations were publicly funded (34.9%) with slightly more funded through industry sources (43.5%). Funding sources varied based on the type of intervention being studied with randomized controlled trials of device, diagnostic, and pharmacological interventions reflecting predominantly industry-funded studies. Over time, studies supporting IA cardiology guideline are funded by industry about twice as often as public sources. Thus, data of adequate quality to support cardiovascular guideline recommendations come from a variety of sources.
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Cardiologia/economia , Guias de Prática Clínica como Assunto , Sociedades Médicas/economia , American Heart Association , Humanos , Projetos de Pesquisa , Estados UnidosRESUMO
PURPOSE OF REVIEW: This study aims to assess the current state of cardio-oncology in reference to advocacy efforts, access to care, and perspective of stakeholders in their ability to provide patient care as well as development of "across the aisle" synergy among cardiologists and oncologists and academic and non-academic centers in various worldwide locations. RECENT FINDINGS: During the last decade, there has been a significant and diverse growth in cardio-oncology. We reviewed the experience from cardiologists and oncologists across different healthcare systems, the global trends, the role of collaborative networks, and the importance of advocacy efforts. Cardio-oncology will continue to grow, but there is an unmet need to increase awareness, improve education, and expand access to care to larger segments of the cancer population in order to have a more significant impact on their health. The growing collaboration through professional societies and collaborative networks provides an opportunity to advance the cardiovascular care of cancer patients to meet the projected needs in a growing and more diverse population.
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Cardiologia , Colaboração Intersetorial , Oncologia , Cardiologia/economia , Cardiologia/educação , Doenças Cardiovasculares/complicações , Acessibilidade aos Serviços de Saúde , Humanos , Oncologia/economia , Oncologia/educação , Neoplasias/complicações , Defesa do Paciente , Mídias SociaisAssuntos
COVID-19 , Cardiologia , SARS-CoV-2 , COVID-19/economia , COVID-19/epidemiologia , COVID-19/terapia , Cardiologia/economia , Cardiologia/educação , HumanosAssuntos
Centros Médicos Acadêmicos , Cardiologia , Escolha da Profissão , Mobilidade Ocupacional , Universidades , Centros Médicos Acadêmicos/economia , Centros Médicos Acadêmicos/organização & administração , Cardiologia/economia , Cardiologia/métodos , Cardiologia/organização & administração , Cardiologia/tendências , Procedimentos Cirúrgicos Cardiovasculares , Humanos , Apoio à Pesquisa como Assunto , Fatores de Tempo , Universidades/economia , Universidades/organização & administraçãoRESUMO
Over the past two decades, Medicare and other payers have been looking at ways to base payment for cardiovascular care on the quality and outcomes of care delivered. Public reporting of hospital performance on a series of quality measures began in 2004 with basic processes of care such as aspirin use and influenza vaccination, and it expanded in later years to include outcomes such as mortality and readmission rates. Following the passage of the Affordable Care Act in March 2010, Medicare and other payers moved forward with pay-for-performance programs, more commonly referred to as value-based purchasing (VBP) programs. These programs are largely based on an underlying fee-for-service payment infrastructure and give hospitals and clinicians bonuses or penalties based on their performance. Another new payment mechanism, called alternative payment models (APMs), aims to move towards episode-based or global payments to improve quality and efficiency. The two most relevant APMs for cardiovascular care include Accountable Care Organizations and bundled payments. Both VBP programs and APMs have challenges related to program efficacy, accuracy, and equity. In fact, despite over a decade of progress in measuring and incentivizing high-quality care delivery within cardiology, major limitations remain. Many of the programs have had little benefit in terms of clinical outcomes yet have led to marked administrative burden for participants. However, there are several encouraging prospects to aid the successful implementation of value-based high-quality cardiovascular care, such as more sophisticated data science to improve risk adjustment and flexible electronic health records to decrease administrative burden. Furthermore, payment models designed specifically for cardiovascular care could incentivize innovative care delivery models that could improve quality and outcomes for patients. This review provides an overview of current efforts, largely at the federal level, to pay for high-quality cardiovascular care and discusses the challenges and prospects related to doing so.
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Cardiologia/economia , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/terapia , Custos de Cuidados de Saúde , Avaliação de Processos e Resultados em Cuidados de Saúde/economia , Reembolso de Incentivo/economia , Cardiologia/normas , Doenças Cardiovasculares/diagnóstico , Custos de Cuidados de Saúde/normas , Humanos , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Pacotes de Assistência ao Paciente/economia , Melhoria de Qualidade/economia , Indicadores de Qualidade em Assistência à Saúde/economia , Reembolso de Incentivo/normas , Resultado do Tratamento , Seguro de Saúde Baseado em Valor/economia , Aquisição Baseada em Valor/economiaRESUMO
In an effort to curb excessive health care spending and incentivize high-quality care, many payers have implemented value-based payment reforms designed to pay for the quality rather than the quantity of health care services. Medicare, the largest payer in the United States, has implemented numerous value-based payment policies over the past decade, many of which affect cardiovascular care. In this review, we discuss some of these major nationwide value-based payment reforms as they relate to cardiovascular care and what we may expect in the future from cardiovascular value-based policies.
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Cardiologia/economia , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/terapia , Custos de Cuidados de Saúde , Reforma dos Serviços de Saúde/economia , Medicare/economia , Avaliação de Processos e Resultados em Cuidados de Saúde/economia , Seguro de Saúde Baseado em Valor/economia , Aquisição Baseada em Valor/economia , Organizações de Assistência Responsáveis/economia , Cardiologia/legislação & jurisprudência , Doenças Cardiovasculares/diagnóstico , Custos de Cuidados de Saúde/legislação & jurisprudência , Reforma dos Serviços de Saúde/legislação & jurisprudência , Política de Saúde , Humanos , Medicare/legislação & jurisprudência , Pacotes de Assistência ao Paciente/economia , Formulação de Políticas , Resultado do Tratamento , Estados Unidos , Aquisição Baseada em Valor/legislação & jurisprudênciaRESUMO
Patient access to a drug after US regulatory approval is controlled by complex interactions between governmental and third-party payers, pharmacy benefit managers, distributers, manufacturers, health systems, and pharmacies that together mediate the receipt of goods by patients after prescription by clinicians. Recent medication approvals highlight why and how the distribution of clinically beneficial novel therapies is controlled. Although imposed limitations on availability may be rational considering the fiduciary responsibilities of payers and escalating spending on health care and pharmaceuticals, transparency and communication are lacking, and some utilization management may disproportionately affect vulnerable populations. Analysis of the current health insurance landscape suggests mechanisms by which patient access to appropriate medications can be improved and patient and clinician frustration reduced while acknowledging the financial realities of the pharmaceutical marketplace. We propose creation of a shared, standardized, and transparent process for coverage decisions that minimizes administrative barriers and is defensible on the basis of clinical and cost-effectiveness evidence. These reforms would benefit patients and improve the efficiency of the pharmaceutical system.
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Doenças Cardiovasculares , Custos de Medicamentos , Seguro de Serviços Farmacêuticos , Preparações Farmacêuticas/economia , Cardiologia/economia , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/economia , Análise Custo-Benefício , Humanos , Estados UnidosRESUMO
Background. Observational economic evaluations (i.e., economic evaluations in which treatment allocation is not randomized) are prone to confounding bias. Prior reviews published in 2013 have shown that adjusting for confounding is poorly done, if done at all. Although these reviews raised awareness on the issues, it is unclear if their results improved the methodological quality of future work. We therefore aimed to investigate whether and how confounding was accounted for in recently published observational economic evaluations in the field of cardiology. Methods. We performed a systematic review of PubMed, Embase, Cochrane Library, Web of Science, and PsycInfo databases using a set of Medical Subject Headings and keywords covering topics in "observational economic evaluations in health within humans" and "cardiovascular diseases." Any study published in either English or French between January 1, 2013, and December 31, 2017, addressing our search criteria was eligible for inclusion in our review. Our protocol was registered with PROSPERO (CRD42018112391). Results. Forty-two (0.6%) out of 7523 unique citations met our inclusion criteria. Fewer than half of the selected studies adjusted for confounding (n = 19 [45.2%]). Of those that adjusted for confounding, propensity score matching (n = 8 [42.1%]) and other matching-based approaches were favored (n = 8 [42.1%]). Our results also highlighted that most authors who adjusted for confounding rarely justified their methodological choices. Conclusion. Our results indicate that adjustment for confounding is often ignored when conducting an observational economic evaluation. Continued knowledge translation efforts aimed at improving researchers' knowledge regarding confounding bias and methods aimed at addressing this issue are required and should be supported by journal editors.
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Cardiologia/economia , Cardiologia/normas , Cardiologia/tendências , Análise Custo-Benefício/métodos , HumanosRESUMO
Challenges and special aspects related to the management and prognosis of pulmonary hypertension (PH) in middle- to low-income regions (MLIRs) range from late presentation to comorbidities, lack of resources and expertise, cost, and rare options of lung transplantation. Expert consensus recommendations addressing the specific challenges for prevention and therapy of PH in MLIRs with limited resources have been lacking. To date, 6 MLIR-PH registries containing mostly adult patients with PH exist. Importantly, the global prevalence of PH is much higher in MLIRs compared with high-income regions: group 2 PH (left heart disease), pulmonary arterial hypertension associated with unrepaired congenital heart disease, human immunodeficiency virus, or schistosomiasis are highly prevalent. This consensus statement provides selective, tailored modifications to the current PH guidelines to address the specific challenges faced in MLIRs, resulting in the first pragmatic and cost-effective consensus recommendations for PH care providers, patients, and their families.
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Hipertensão Pulmonar/economia , Hipertensão Pulmonar/terapia , Pobreza/economia , Pobreza/tendências , Cardiologia/economia , Cardiologia/tendências , Cardiopatias Congênitas/economia , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/terapia , Humanos , Hipertensão Pulmonar/epidemiologia , Transplante de Pulmão/economia , Transplante de Pulmão/tendências , Sistema de Registros , Literatura de Revisão como AssuntoAssuntos
Pesquisa Biomédica/tendências , Cardiologia/tendências , Doenças Cardiovasculares , Apoio à Pesquisa como Assunto/tendências , Pesquisa Biomédica/economia , Cardiologia/economia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/terapia , Bases de Dados Factuais , Europa (Continente) , Humanos , Apoio à Pesquisa como Assunto/economia , Fatores de TempoAssuntos
Cardiologia , Doenças Cardiovasculares/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Avaliação de Processos e Resultados em Cuidados de Saúde , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Tomografia Computadorizada por Raios X , Cardiologia/economia , Cardiologia/educação , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/terapia , Competência Clínica , Angiografia por Tomografia Computadorizada/economia , Angiografia por Tomografia Computadorizada/instrumentação , Educação Médica , Custos de Cuidados de Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Reembolso de Seguro de Saúde , Valor Preditivo dos Testes , Melhoria de Qualidade/economia , Indicadores de Qualidade em Assistência à Saúde/economia , Tomógrafos Computadorizados , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/instrumentação , Resultado do TratamentoRESUMO
Background and Purpose- Industry payments to physicians raise concerns regarding conflicts of interest that could impact patient care. We explored nonresearch and nonownership payments from industry to vascular neurologists to identify trends in compensation. Methods- Using Centers for Medicare and Medicaid Services and American Board of Psychiatry and Neurology data, we explored financial relationships between industry and US vascular neurologists from 2013 to 2018. We analyzed payment characteristics, including payment categories, payment distribution among physicians, regional trends, and biomedical manufacturers. Furthermore, we analyzed the top 1% (by compensation) of vascular neurologists with detailed payment categories, their position, and their contribution to stroke guidelines. Results- The number of board certified vascular neurologist increased from 1169 in 2013 to 1746 in 2018. The total payments to vascular neurologist increased from $99 749 in 2013 to $1 032 302 in 2018. During the study period, 16% to 17% of vascular neurologists received industry payments. Total payments from industry and mean physician payments increased yearly over this period, with consulting fee (31.1%) and compensation for services other than consulting (30.7%) being the highest paid categories. The top 10 manufacturers made the majority of the payments, and the top 10 products changed from drug or biological products to devices. Physicians from south region of the United States received the highest total payment (38.72%), which steadily increased. Payments to top 1% vascular neurologists increased from 64% to 79% over the period as payments became less evenly distributed. Among the top 1%, 42% specialized in neuro intervention, 11% contributed to American Heart Association/American Stroke Association guidelines, and around 75% were key leaders in the field. Conclusions- A small proportion of US vascular neurologists consistently received the majority of industry payments, the value of which grew over the study period. Only 11% of the top 1% receiving industry payments have authored American Heart Association/American Stroke Association guidelines, but ≈75% seem to be key leaders in the field. Whether this influences clinical practice and behavior requires further investigation.
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Cardiologia/economia , Cardiologia/tendências , Conflito de Interesses/economia , Neurologistas/economia , Neurologistas/tendências , Cardiologia/legislação & jurisprudência , Centers for Medicare and Medicaid Services, U.S./economia , Centers for Medicare and Medicaid Services, U.S./legislação & jurisprudência , Centers for Medicare and Medicaid Services, U.S./tendências , Conflito de Interesses/legislação & jurisprudência , Bases de Dados Factuais/tendências , Indústria Farmacêutica/economia , Indústria Farmacêutica/legislação & jurisprudência , Indústria Farmacêutica/tendências , Setor de Assistência à Saúde/economia , Setor de Assistência à Saúde/legislação & jurisprudência , Setor de Assistência à Saúde/tendências , Humanos , Neurologistas/legislação & jurisprudência , Fatores de Tempo , Estados UnidosRESUMO
European guidelines on cardiovascular prevention in clinical practice were first published in 1994 and have been regularly updated, most recently in 2016, by the Sixth European Joint Task Force. Given the amount of new information that has become available since then, components from the task force and experts from the European Association of Preventive Cardiology of the European Society of Cardiology were invited to provide a summary and critical review of the most important new studies and evidence since the latest guidelines were published. The structure of the document follows that of the previous document and has six parts: Introduction (epidemiology and cost effectiveness); Cardiovascular risk; How to intervene at the population level; How to intervene at the individual level; Disease-specific interventions; and Settings: where to intervene? In fact, in keeping with the guidelines, greater emphasis has been put on a population-based approach and on disease-specific interventions, avoiding re-interpretation of information already and previously considered. Finally, the presence of several gaps in the knowledge is highlighted.