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4.
Value Health Reg Issues ; 8: 92-98, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26543802

RESUMO

BACKGROUND: Radiofrequency ablation (RFA) is an established but expensive treatment alternative for many forms supraventricular tachycardia (SVT). Currently no studies exist on the cost-effectiveness of RFA compared to medical treatment (MT) in adult Latin American population. METHODS: Between 2007 and 2012, we identified 103 adults who underwent RFA for SVT in the National Unit of Cardiovascular Surgery (UNICAR) in Guatemala. A decision tree was developed with all clinical outcome parameter estimates obtained from the Adult Electrophysiology Clinic. Costs were obtained from UNICAR's administration. A cost-effectiveness analysis was conducted which evaluated costs and quality adjusted life years (QALYs) to compare interventions in terms of their incremental cost-effectiveness ratios (ICERs). RESULTS: The first RFA had 83% success and cumulative 94% success was achieved with a second one. The cost of the RFA procedure itself was $5,411. RFA gains 1.46 QALYs and saves $ 7,993 compared to of MT for patients with SVT. This demonstrates that in Guatemala, RFA dominates MT in the management of SVT. Using assumptions based largely on the outcomes in UNICAR, we found that the RFA is highly cost-effective. This is a consistent finding, even after varying assumptions about efficacy, complication rates and quality of life. CONCLUSIONS: RFA dominates MT by improving quality of life and reducing expenditures when used to treat severely symptomatic patients with SVT in Guatemala. The robustness of these finding to variations in parameter assumptions, suggests these findings may hold in other similar settings.

5.
Value Health Reg Issues ; 8: 92-98, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29698177

RESUMO

BACKGROUND: Radiofrequency ablation (RFA) is an established but expensive treatment alternative for many forms of supraventricular tachycardia (SVT). Currently, no studies exist on the cost-effectiveness of RFA compared with that of medical treatment (MT) in adult Latin American population. METHODS: Between 2007 and 2012, we identified 103 adults who underwent RFA for SVT in the National Unit of Cardiovascular Surgery (Unidad Nacional de Cirugía Cardiovascular [UNICAR]) in Guatemala. A decision tree was developed with all clinical outcome parameter estimates obtained from the Adult Electrophysiology Clinic. Cost data were obtained from UNICAR's administration. A cost-effectiveness analysis that evaluated costs and quality-adjusted life-years to compare interventions in terms of their incremental cost-effectiveness ratios was conducted. RESULTS: The first RFA had an 83% success rate, and a cumulative success rate of 94% was achieved with a second. The cost of the RFA procedure itself was $5411. RFA gained 1.46 quality-adjusted life-years and saved $7993 compared with MT for patients with SVT. This demonstrates that in Guatemala, RFA dominates MT in the management of SVT. Using assumptions based largely on the outcomes in UNICAR, we found that RFA is highly cost-effective. This is a consistent finding, even after varying assumptions about efficacy, complication rates, and quality of life. CONCLUSIONS: RFA dominates MT by improving quality of life and reducing expenditures when used to treat patients with severe symptoms of SVT in Guatemala. The robustness of these finding to variations in parameter assumptions suggests that these findings may hold in other similar settings.

6.
Rev. guatem. cardiol. (Impresa) ; 23(2): 55-56, jun.-dic. 2013. ilus
Artigo em Espanhol | LILACS | ID: biblio-869900

RESUMO

La cardiomiopatía por estrés (de Takotsubo) es un síndrome caracterizado por disfunción ventricular izquierda transitoria, con anomalías de la contractilidad características, predominantemente a nivel apical. Presentamos el caso de un niño de 2 años quién desarrolló una cardiomiopatía de Takotsubo después del cierre quirúrgico de una comunicación interventricular. Este síndrome es poco común en niños, y a nuestro conocimiento, este es el primer caso de este tipo de cardiomiopatía tras cirugía cardíaca en un niño.


Assuntos
Humanos , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnóstico , Estresse Fisiológico
7.
Artigo em Inglês | MEDLINE | ID: mdl-19349009

RESUMO

A large underserved population of children with congenital cardiac malformation (CCM) exists in many developing countries. In recent years, several strategies have been implemented to supplement this need. These strategies include transferring children to first-world countries for surgical care or the creation of local pediatric cardiovascular surgical programs. In 1997, an effort was made to create a comprehensive pediatric cardiac care program in Guatemala. The objective of this study is to examine the outcome analysis of the Guatemala effort. The goals of our new and first pediatric cardiac care program were to: 1) provide diagnosis and treatment to all children with a CCM in Guatemala; 2) train of local staff surgeons, 3) established a foundation locally and in the United States in 1997 to serve as a fundraising instrument to acquire equipment and remodeling of the pediatric cardiac unit and also to raise funds to pay the hospital for the almost exclusively poor pediatric cardiac patients. The staff now includes 3 surgeons from Guatemala, trained by the senior surgeon (A.R.C.), seven pediatric cardiologists, 3 intensivists, and 2 anesthesiologists, as well as intensive care and ward nurses, respiratory therapists, echocardiography technicians, and support personnel. The cardiovascular program expanded in 2005 to 2 cardiac operating rooms, 1 cardiac catheterization laboratory, 1 cardiac echo lab, 4 outpatients clinics a 6-bed intensive care unit and a 4-bed stepdown unit, a 20 bed general ward (2 beds/room) and a genetics laboratory. Our center has become a referral center for children from Central America. A total of 2,630 surgical procedures were performed between February 1997 and December 2007, increasing the number of operations each year. Postoperative complication occurred in 523 of 2,630 procedures (20%). A late follow-up study was conducted of all the patients operated from 1997 to 2005. Late mortality was 2.7%. Development of a sustainable pediatric cardiac program in emerging countries presents many difficult challenges. Hard work, perseverance, adaptability, and tolerance are useful aptitudes to develop a viable PCP in an "emerging" country. We are not in favor of Medical-Surgical Safari efforts, unless these efforts include training of a local team and eventual unit independence. It helps if an experienced (+/- senior/retired!) surgeon leads this effort on a full-time, pro bono basis. Local and international fund raising is essential to complement vastly insufficient government subsidies.


Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Cardiopatias Congênitas/cirurgia , Programas Nacionais de Saúde/organização & administração , Avaliação de Resultados em Cuidados de Saúde , Pediatria , Países em Desenvolvimento , Bolsas de Estudo , Guatemala/epidemiologia , Cardiopatias Congênitas/epidemiologia , Humanos , Objetivos Organizacionais , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde
8.
Pediatr Cardiol ; 27(4): 434-9, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16830085

RESUMO

The objective of this study is to provide results and costs of catheter ablation in children and adolescents in a low-income country. Reports from first-world countries have demonstrated the cost-effectiveness of radiofrequency catheter ablation (RFCA) compared to medical treatment of supraventricular tachycardia (SVT). The study included 28 patients younger than 18 years of age with SVT in a pediatric cardiology unit in Guatemala. All patients underwent RFCA. Clinical outcome and cost-effectiveness of RFCA compared to continued medical treatment were the end points. Twenty-four patients had successful ablation (85.7%). Mean age at RFCA was 11.42 +/- 3.49 years. Three patients underwent a second ablation, increasing the success rate to 96.4%. One remaining patient is awaiting a second procedure. At a mean follow-up of 13.69 +/- 7.16 months, all 27 patients who had a successful ablation remained in sinus rhythm. Mean cost per procedure was 4.9 times higher than that of medical treatment. However, the estimated cost of catheter ablation equal that of medical therapy after 5.1 years and is 3.4 times less after 20 years. Radiofrequency catheter ablation of SVT in children and adolescents is safe and cost-effective compared to medical therapy. Resources must be judiciously allocated, especially in low-income countries, to treat the largest number of pediatric patients.


Assuntos
Ablação por Cateter/economia , Taquicardia Supraventricular/economia , Taquicardia Supraventricular/cirurgia , Adolescente , Antiarrítmicos/economia , Antiarrítmicos/uso terapêutico , Ablação por Cateter/efeitos adversos , Criança , Análise Custo-Benefício , Técnicas Eletrofisiológicas Cardíacas , Estudos de Viabilidade , Feminino , Seguimentos , Guatemala , Humanos , Masculino , Reoperação , Estudos Retrospectivos , Taquicardia Supraventricular/tratamento farmacológico , Resultado do Tratamento
9.
Cardiol Young ; 12(6): 542-8, 2002 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-12636002

RESUMO

Discordant atrioventricular connections associated with Wolff-Parkinson-White syndrome increase the challenge of radiofrequency ablation. We report the results and techniques of radiofrequency ablation in three patients with discordant atrioventricular connections, including one patient having double outlet right ventricle with atrioventricular reentry tachycardias. There were two males and one female, aged 14 and 22 years old. We found four accessory pathways during our electrophysiological studies, with two of them manifest on the electrocardiogram, corresponding to left paraseptal and right midseptal regions. The electrophysiological study confirmed this localization, and showed two concealed accessory pathways in the right and left paraseptal regions. Radiofrequency ablation was successful in all cases without recurrence at a mean follow-up of 18.6 months. No complications were observed during the procedures. We conclude that radiofrequency ablation is feasible and effective in the ablation of accessory pathways in patients with discordant atrioventricular connections.


Assuntos
Nervo Acessório/patologia , Nervo Acessório/cirurgia , Nó Atrioventricular/patologia , Nó Atrioventricular/cirurgia , Ablação por Cateter , Adolescente , Adulto , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Seguimentos , Bloqueio Cardíaco/complicações , Bloqueio Cardíaco/cirurgia , Humanos , Masculino , México , Taquicardia por Reentrada no Nó Atrioventricular/complicações , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Resultado do Tratamento , Síndrome de Wolff-Parkinson-White/complicações , Síndrome de Wolff-Parkinson-White/cirurgia
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