The Burden of Atrial Fibrillation on the Hospital Sector in Canada

Background

Atrial fibrillation (AF) is a common disease that frequently requires acute hospital care; however, the cost of hospital care in Canada has not been reported. The purpose of this study was to estimate the cost of AF related to hospital-based care in Canada.

Methods

Analyses were conducted with 2 national administrative databases for the fiscal year 2007-2008. Databases included information for hospital admissions, day operations, and ambulatory care. Records with a most responsible diagnosis of AF, atrial flutter, or a diagnosis related to AF with a concomitant comorbidity of AF were included. Hospital costs were estimated, in 2010 Canadian dollars, by applying an average cost per weighted case to the resource intensity weight for each admission or visit and then adding the separate billable fee for admissions, surgical procedures, and interventions.

Results

In 2007-2008, the number of acute care admissions with AF as the most responsible diagnosis was 22,823, same-day surgical procedures was 5707, and emergency department visits was 58,066. The hospital costs attributable to AF were $815 million in 2010 Canadian dollars: $710 million for hospitalizations; $32 million for same-day surgical procedures; and $73 million for emergency department visits. Most of the acute care costs were for hospitalizations when AF was listed as a comorbidity ($558 million, or 69%).

Conclusion

AF results in a substantial cost burden to the acute care hospital sector. Current hospital costs in AF patients are driven by the consequences of AF, while the costs for specific treatments for AF are relatively low.     

Factores asociados con el control del asma en pacientes de atención primaria en España: el estudio CHAS

Background

Asthma control is inadequate in all populations studied to date, leading to a major part of the cost of the disease. The aim of our study was to evaluate the prevalence of uncontrolled asthma in primary care patients and identify the associated factors.

Methods

We carried out a cross-sectional study of the population of primary care asthmatic patients over 18 years old in Spain (n=2159). Asthma control was measured with the Asthma Control Questionnaire (ACQ). The sociodemographic variables and treatment compliance were measured using a questionnaire. We built logistic-regression models using Asthma control, a dichotomous variable generated from ACQ score.

Results

The prevalence of uncontrolled asthma was 63.9%. Treatment with oral corticosteroids (OCS) (OR=6.55), greater asthma severity (OR=3.11), presence of a distressing event (OR=2.44), lower significance given to treatment compliance (OR=1.66) and living in a rural area (OR=1.29) are associated with uncontrolled asthma. On the contrary, sex, age, obesity, smoking, alcohol intake and educational level had no effect on asthma control.

Conclusions

In Spain asthma is still uncontrolled and some factors leading to this situation appear to be modifiable by the health system.     

Análisis del coste del trasplante hepático en un hospital de la comunidad: su relación con el Model for End-stage Liver Disease,un índice pronóstico que prioriza al paciente más grave

Introduction

The aim of the present study was to investigate the impact of the Model for End-stage Liver Disease (MELD) on transplantation costs.

Material and methods

We included all patients who received a liver transplant for end-stage liver disease between 2006 and 2010. The study period encompassed the day of transplantation until hospital discharge. The patients were classified into two groups: those with a MELD score of 6-19 and those with a score of 20-40.

Results

The mean MELD score at transplantation was 19.2 ± 7.0 (mean ± SD). The mean cost per procedure in the study period was USD 33,461 per patient (range 21,795-104,629). The cost of transplantation was USD 30,493 ± 8,825 in patients with a MELD score of 6-19 and was USD 36,506 ± 15,833 in those with a score of 20-40; this difference was statistically significant (P = .04). In a stepwise logistic regression analysis, the only independent predictor of high cost was having a MELD score of 20 (OR 11.8; CI 1.6-87). In the linear regression model, the most important predictor of cost was the length of hospital stay (r² = 43%).

Discussion

Our results demonstrate that the MELD score directly affects transplantation costs. We suggest that reimbursement systems compensate the distinct financing bodies according to the severity of the underlying disease, evaluated with the MELD.     

Evaluación económica de la elastografía de transición (FibroScan) en el diagnóstico de fibrosis hepática en pacientes con hepatitis C coinfectados con VIH

Introduction

The assessment of liver fibrosis is crucial for taking therapeutic decisions in patients infected with HIV/AIDS coinfected with HCV, because it allows the prognosis of the disease and the prioritization of hepatitis C treatment in these patients.

Methods

A discrete events model simulation (DEMS) and a Markov model have been developed to represent the evolution of liver fibrosis to cirrhosis in patients coinfected with HIV/HVC. The model evaluated two alternatives for the diagnosis and monitoring of these patients, transient elastography performed annually and liver biopsy performed every seven years. The models have been developed under Health Care System perspective and only considered direct medical costs (disease treatment and health state costs). One-way sensitivity analyses were carried out to assess the impact of parameters with higher uncertainty. A discount rate of 3% was applied.

Results

Base case analysis shows that the diagnosis and monitoring of patients with transient elastography is a dominant strategy compared with to liver biopsy, resulting in greater life expectancy at lower cost. The sensitivity analysis performed confirmed the robustness of these results.

Conclusion

Transient elastography has proved to be a dominant strategy compared to liver biopsy in the diagnosis and monitoring of liver fibrosis in patients coinfected with HIV/HCV in Spain.     

Tratamiento antirretroviral de inicio en pacientes infectados por el virus de la inmunodeficiencia humana en España: decisiones con relación a características inmunovirológicas específicas (estudio PERFIL-es)

Introduction

The purpose of Perfil-es study was to identify the proportion of patients starting ARV treatment based on NNRTIs or PI/r, and to identify the variables involved in the therapeutic decision-making in standard clinical practice.

Methods

An observational restrospective study performed in 65 Spanish hospitals.

Results

Was a total of 1,687 starts: 53% with NNRTI-based regimen and 42% with PI/r, and of the 642 patients analyzed, 72% had a CD4 count < 350 cells/μl.

Conclusion

The initiation of ARV treatment is still late in Spain. NNRTIs are the more frequent choice, although PI/r plays an important role.     

Estudio de coste-efectividad del manejo diagnóstico del derrame pleural en una unidad de patología pleural ambulatoria

Objective

To evaluate the diagnostic efficacy of pleural procedures, safety, delay and cost of the diagnosis of pleural effusion (PE) by analysing the parameters that are dependent on the area of patient management (outpatient or inpatient).

Patients and Methods

Prospective non-randomized study. Two groups were established depending on whether they were managed in a specific outpatient unit or as a conventional hospital inpatient, with the rest of the criteria being the same for the study of the PE.

Results

We included 60 outpatients and 34 inpatients. The median number of visits as an outpatient was 2 (range 2–3), and the time an inpatient was hospitalized was 13 (range 7.7–25–2) days. The number of analytical and imaging studies was significantly higher in the inpatient group. There were no differences in the number of cytology and pleural biopsies, or complications between groups. There were no differences in time to performing computed tomography. The number of days until the pleural biopsy and the time until to obtain a diagnosis was lower in the outpatient group. Mean total cost for an outpatient was €1.352 and €9.793,2 for inpatients.

Conclusions

Management of ambulatory diagnosis of PE patients is highly cost-effective. The effectiveness and safety of forms of the study is at least similar. In this study, the mean cost for a hospitalised inpatient for a PE was 7.2 times higher than outpatient management.     

Cost-of-illness studies of diabetes mellitus: A systematic review

Background

Diabetes mellitus (DM) is recognised as a major health problem.

Objectives

The aims of this study are two-fold: (1) to describe the methods used in the identified cost-of-illness (COI) studies of DM and (2) to summarise their study findings regarding the economic impact of DM.

Methods

This is a systematic review of MEDLINE and Scopus journal articles reporting the cost of type 1 and/or 2 DM that were published in English from 2007 to 2011. Costs reported in the included studies were converted to US dollars.

Results

The systematic search yielded 30 articles. The studies varied considerably in their study design, perspective and included cost categories. Estimates for the total annual costs of DM ranged from US$141.6 million to US$174 billion; direct costs ranged from US$150 to US$14,060 per patient per year (pppy) whereas indirect costs ranged from US$39.6 to US$7,164 pppy. Inpatient cost was the major contributor to direct cost in half of the studies that included inpatient costs, physician services and medications.

Conclusion

There is a considerable economic burden associated with DM. Future research should focus on improving methods of estimating costs, enhancing the interpretation of study findings and facilitating comparisons between studies.     

Implantación de una prueba rápida de VIH en Asturias (España)

Introduction

The aim of the study was to analyze the implementation of a rapid HIV test in Asturias (Spain).

Methods

The study was conducted in two STI Units using the Determine^® HIV-1/2 test.

Results

A total of 1011 people were tested, of whom 65.3% had never been tested for HIV previously, and 71.4% were heterosexual men. Twenty-one tests were confirmed positive by Enzyme Immunoassay/Western Blot (EIA/WB) assay An increase was observed in the diagnosis of HIV.

Conclusion

Awareness campaigns and rapid tests could be effective methods for the early diagnosis of HIV.     

Long-term mortality and hospital readmission after acute myocardial infarction: an eight-year follow-up study

Introduction and objectives

Acute myocardial infarction is responsible for most of the deaths in developed countries and for a very large number of hospital admissions. Specifically in Spain, each year about 140 000 deaths and 5 million hospital stays are due to acute myocardial infarction, corresponding to health care costs reaching 15% of total expenditure. Therefore, this paper presents an exhaustive analysis of acute myocardial infarction and the related prognosis, such as recurrence and mortality.

Methods

This observational study was carried out in Spain. Data were obtained using the Hospital Discharge Administrative Database from 2000 through 2007, inclusive. Specifically, 12 096 cases of acute myocardial infarction (8606 women and 3490 men) were reported during this period, with 2395 readmissions for this diagnosis. Readmissions were analyzed for frequency and duration using logistic regression and the Wang survival model. Mortality was analyzed using logistic regression.

Results

Readmission rates were 50% for patients younger than 45 years and 38% for those older than 75 years (P<.001). Men were readmitted more frequently than women throughout the follow-up period. Variables related to hospital mortality from acute myocardial infarction were the presence of diabetes, previous ischemic heart disease, and cerebrovascular disease.

Conclusions

Mid-term hospital readmissions are highly frequent in acute myocardial infarction survivors. Male sex, previous coronary heart disease, and the number of classical cardiovascular risk factors are the major risk predictors of this readmission. Our results highlight the need for improved medical care during acute myocardial infarction admission, integrated into secondary prevention programs.Full English text available from:www.revespcardiol.org     

Análisis transversal de la resincronización cardiaca en España. Indicaciones,técnicas de implante,optimización y seguimiento

Introduction and objectives

A cross-sectional study of cardiac resynchronization therapy use in Spain was performed to analyze problems with indications, implantation, and patient follow-up.

Methods

Spanish cardiac resynchronization therapy implanter centers were identified, then the department members were surveyed and the data were recorded by each implantation team.

Results

Eighty-eight implanter centers were identified; of these, 85 (96.6%) answered the survey. A total of 2147 device implantations were reported, comprising 85.6% of the overall number of 2518 implantations estimated by the European Confederation of Medical Suppliers Associations for the same period. The reported implantation rate was 46 per million inhabitants versus an estimated implantation rate of 51 per million (European average, 131). Cardiac resynchronization therapy devices accounted for 84% of implantations, and upgrades to previously implanted devices, 16%. The majority of cardiac resynchronization therapy devices were implanted in men (70.7%). The mean age was 68 (12) years, and the mean left ventricular ejection fraction was 26.4% (5%). Most patients (67%) were in New York Heart Association functional class III. The group of patients for whom cardiac resynchronization therapy was indicated according to the latest update of the guidelines was significant: 17.3% among New York Heart Association class II patients and more than 21.6% among patients with atrial fibrillation. In all, electrophysiologists accounted for 73.8% of implanters, followed by surgeons, accounting for 21.4%.

Conclusions

The latest update of the guidelines is being progressively implemented in Spain, according to data obtained in patients in New York Heart Association class II or with atrial fibrillation. Nevertheless, the number of cardiac resynchronization therapy device implants is still well below the European average.Full English text available from:www.revespcardiol.org     

Registro Español de Hemodinámica y Cardiología Intervencionista. XXI Informe Oficial de la Sección de Hemodinámica y Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2011)

Introduction and objectives

The Working Group on Cardiac Catheterization and Interventional Cardiology presents a yearly report on the data collected for the national registry. This information shows how procedures are distributed throughout Spain and makes comparisons with other countries feasible.

Methods

Institutions provided their data voluntarily (online) and were analyzed by the Working Group's Steering Committee.

Results

Data were provided by 108 hospitals (72 public and 36 private) that mainly treat adults, Covering 138 480 diagnostic procedures, 123 746 of which were coronary angiograms, slightly more than the year before, with a rate of 3008 coronary angiograms per million population. Percutaneous coronary interventions decreased slightly to 63 202 procedures with a rate of 1373 interventions per million population. Of the 94 701 stents implanted, 61% were drug-eluting stents. In the acute phase of myocardial infarction, 15 491 coronary interventions were performed, 9.4% more than in 2010, representing 24.6% of the total number of coronary interventions. The most frequent intervention for adult congenital heart disease was atrial septal defect closure (298 procedures). Percutaneous mitral valvuloplasty continued to decrease (286 procedures) and percutaneous aortic valve implantations increased, but at a slower pace than in the previous year, with 770 units implanted in 2011.

Conclusions

The greatest increase in activity has occurred in the field of myocardial infarction and percutaneous aortic valve implantation. The number of other procedures, both diagnostic and therapeutic, remained stable.Full English text available from: www.revespcardiol.org     

Infecciones neonatales por Staphylococcus aureus de inicio en la comunidad

Introduction

Staphylococcus aureus is a major cause of neonatal community-onset infections. The emergence of methicillin-resistant S. aureus infections in this age group has been reported in USA in the last few years; however there are no studies in Spain. The aim of this study is to describe the epidemiological, clinical and microbiological characteristics of S. aureus community-onset infections in neonates.

Methods

We prospectively reviewed the S. aureus infections in neonates over a three year period (2007-2009) in the Pediatric Emergency Department of Hospital 12 de Octubre in Madrid (Spain).

Results

We recorded 30 cases of neonatal S. aureus community-onset infections. Only one isolated (3.3%) was resistant to methicillin, and two (6.7%) were PVL(+).

Conclusions

Despite the emergence of MRSA outside the hospital in pediatric population in Spain, CA-MRSA and SA PVL(+) infections are not frequent in neonates.     

Patrón de inicio del seguimiento clínico en los pacientes con infección por el virus de la inmunodeficiencia humana en España

Objetive

To describe linkage to care among new HIV diagnoses in Spain; and to estimate factors associated to linkage to care within three months after diagnosis.

Methods

The distribution of the time elapsing between the date of HIV diagnosis and the date of first determination of CD4 (considered to be the date of linkage to care) was calculated among new HIV diagnoses in 2010 in the seven Autonomous Regions participating, where data on date of CD4 count was available. Linkage to care was considered «correct» if done within three months after diagnosis. Factors associated to correct linkage to care were estimated using logistic regression.

Results

A total of 1769 new HIV diagnoses were included. Of them, 83.1% had evidence of linkage to care within a year, and 75.7% were linked within three months after diagnosis. Being an injectable drug user (IDU) was the only factor inversely associated with linkage to care within 3 months (OR = 0.3; 95% CI: 0.2-0.6).

Conclusion

In Spain linkage to care after HIV diagnosis is good, but there is still room for improvement, especially among IDUs.     

Contaminación del aire y síntomas recientes de asma,rinitis alérgica y eccema atópico en escolares de 6 y 7 años

Objective

The objective of the study was to analyze the relationship between air pollutants and the prevalence of recent symptoms of asthma, allergic rhinitis, and atopic eczema in schoolchildren aged between 6 and 7 years.

Patients and Methods

The prevalence of recent (previous 12 months) symptoms of allergic diseases was obtained by means of the questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC), Spain, with the participation of 7 centers (Asturias, Barcelona, Bilbao, Cartagena, La Coruña, Madrid, and Valencia) and 20 455 schoolchildren aged between 6 and 7 years, from 2002 to 2003. The pollutant detection systems of the aforementioned centers provided the mean annual concentrations of sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and total suspended particulate matter.

Results

The annual average concentration of SO₂ showed a significant association with a higher prevalence of recent severe asthma (adjusted odds ratio [aOR] between level-1 and level-3 pollution, 1.32; 95% confidence interval [CI], 1.01–1.73), rhinitis (aOR, 1.56; 95% CI, 1.39–1.75), and rhinoconjunctivitis (aOR, 1.70; 95% CI, 1.45–2.00). The annual average concentration of CO was associated with a higher prevalence of rhinitis (aOR, 1.65; 95% CI, 1.34–2.04), rhinoconjunctivitis (aOR, 1.76; 95% CI, 1.31–2.37), and eczema (aOR, 1.55; 95% CI, 1.17–2.04). The annual average concentration for NO₂ and total suspended particulate matter showed inverse associations with the prevalence of nocturnal dry cough.

Conclusions

Findings suggest that air pollutants such as SO₂ and CO increase the risk of recent symptoms of asthma and allergic rhinitis in schoolchildren aged between 6 and 7 years in Spain.     

Evolución de la mortalidad por asma en España, 1960–2005

Background and Objective

No data have been published on trends in asthma mortality in Spain between 1960 and 2005. The aim of this study was to trace these trends for both the general population and the 5- to 34-year age group in Spain.

Material and Methods

The data on asthma mortality for the general population and by age and sex were obtained from the Spanish National Institute of Statistics and used to calculate the asthma mortality rates per 100 000 inhabitants.

Results

The overall asthma mortality rate per 100 000 inhabitants was 9.36 in 1960 and 2.22 in 2005, showing a reduction from 12.26 to 0.96 in males and from 6.58 to 3.44 in females. In the 5- to 34-year age group, the mortality rate for both sexes ranged from 0.4 to 0.1, showing great variability over time.

Conclusions

Asthma mortality decreased in the period analyzed, but less in women than in men. The trend and rates in Spain are similar to those of most countries for which data are available.     

Registro Español de Desfibrilador Automático Implantable. VIII Informe Oficial del Grupo de Trabajo de Desfibrilador Automático Implantable de la Sociedad Española de Cardiología (2011)

Introduction and objectives

To summarize the findings of the Spanish Implantable Cardioverter-Defibrillator Registry for 2011 compiled by the Electrophysiology and Arrhythmia Section of the Spanish Society of Cardiology.

Methods

Each implantation team voluntarily and prospectively recorded data on a data collection form, which was then sent to the Spanish Society of Cardiology.

Results

Overall, 4481 device implantations were notified, representing 83.6% of the estimated total number of implantations. The notified implantation rate was 97 per million population and the estimated total implantation rate was 116.2 per million. First implantations accounted for 70.2% of the total notified. Data were collected from 167 hospitals (22 more than in 2010). Most implantable cardioverter-defibrillator implantations took place in men (82.1%). The mean age was 62.4 (14.1) years. Most patients had severe or moderate-to-severe ventricular dysfunction and were in New York Heart Association functional class II. The most frequent underlying cardiac condition was ischemic heart disease, followed by dilated cardiomyopathy. The number of indications for primary prevention increased over the previous year and accounted for 70.6% of first implantations. Overall, 78.4% of implantable cardioverter-defibrillators were implanted by cardiac electrophysiologists.

Conclusions

The 2011 Spanish Implantable Cardioverter-Defibrillator Registry includes data on almost 84% of all implantations of these devices performed in Spain. This was the first year in which the number of implants decreased slightly from the previous year, as also occurred in the rest of Europe. The percentage of implants for primary prevention continued to increase.Full English text available from:www.revespcardiol.org