RESUMEN
OBJECTIVES: To estimate the burden of disease attributable to obesity and overweight conditions using disability-adjusted life-years (DALYs) in Colombia. METHODS: The burden of disease was estimated following an adapted methodology published by the World Health Organization. A selection of diseases was performed in which overweight and obesity are risk factors. DALYs were calculated by obtaining the proportion of cases and deaths of every disease that can be attributable to obesity and overweight conditions. The economic impact of obesity was calculated by multiplying the cost of care per patient for each comorbidity by the number of cases attributable exclusively to obesity. RESULTS: A total of 997 371 DALYs were estimated, 45% of which corresponded to men; 81% of DALYs corresponded to years lived with disability. Conditions with greater attributable DALYs are, in order, hypertension (31.6% of the total DALYs), type 2 diabetes mellitus (28.0%), cardiac ischemic disease (14.6%), and lower back pain (11.2%). An estimation of 20.5 DALYs per 1000 inhabitants was made. The economic impact of care for comorbidities associated with obesity could amount to $2158 million. CONCLUSIONS: Obesity and overweight conditions are related to higher mortality and disability than previously estimated; effective interventions aimed at prevention and treatment will have a high impact on quality of life.
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Costo de Enfermedad , Obesidad/complicaciones , Sobrepeso/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Colombia/epidemiología , Diabetes Mellitus Tipo 2/economía , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/etiología , Femenino , Humanos , Hipertensión/economía , Hipertensión/epidemiología , Hipertensión/etiología , Dolor de la Región Lumbar/economía , Dolor de la Región Lumbar/epidemiología , Dolor de la Región Lumbar/etiología , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/economía , Isquemia Miocárdica/epidemiología , Isquemia Miocárdica/etiología , Obesidad/economía , Obesidad/epidemiología , Sobrepeso/economía , Sobrepeso/epidemiología , Años de Vida Ajustados por Calidad de Vida , Factores de RiesgoRESUMEN
BACKGROUND: Coronary artery disease is the most prevalent cardiovascular disease. In the United States, 7% of adults over 20 years of age are estimated to have coronary artery disease. In Brazil, a prevalence of 5 to 8% has been estimated in adults over 40 years of age, with an increased number of hospitalizations associated with both stable and acute clinical manifestations; and health care costs have quadrupled in the last decade. To estimate the direct costs of managing ischemic heart disease patient care in a teaching hospital in Brazil from the perspective of the service payer, the Brazilian Unified Health System. METHODS: This study was a retrospective cohort study for the identification and valuation of resources used at both the outpatient and in-hospital levels in a sample of 330 patients selected from the hospital's ischemic heart disease clinic. Data were collected from computerized hospital records and patients' hospital bills from January 2000 to October 2015. A bivariate analysis and binary logistic regression were performed with p < 0.05 considered statistically significant. RESULTS: The study population consisted of 330 patients with a mean age 61 ± 10 years and a follow-up period of 107 ± 2.6 months; of the patients, 55% were male, 89% had hypertension, 48% had diabetes, and 65% had acute myocardial infarction. The mean annual cost of outpatient management was US $1,521 per patient. The mean cost per hospitalization was US $1,976, and the expenses were higher in the first and last years of follow-up. Unstable angina, revascularization procedures, diabetes, hypertension and obesity were predictors of higher hospitalization costs (p <0.05). CONCLUSION: The cost estimates in this study indicate a high proportion of drug treatment costs in the treatment of ischemic heart disease. Treatment costs are higher in the first year and at the end of treatment, and some clinical factors are associated with greater hospital care costs. These results may serve as a basis for the evaluation of existing public policies and inputs for cost-effectiveness studies in coronary artery disease. TRIAL REGISTRATION: CEP HCPA 11-0460 . Ethics Committee of Hospital de Clínicas de Porto Alegre.
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Atención Ambulatoria/economía , Costos de Hospital , Hospitales de Enseñanza/economía , Isquemia Miocárdica/economía , Isquemia Miocárdica/terapia , Evaluación de Procesos, Atención de Salud/economía , Anciano , Brasil/epidemiología , Fármacos Cardiovasculares/economía , Fármacos Cardiovasculares/uso terapéutico , Comorbilidad , Costos de los Medicamentos , Femenino , Humanos , Modelos Lineales , Modelos Logísticos , Masculino , Persona de Mediana Edad , Modelos Económicos , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: The value of drug-eluting stents in preventing cardiovascular events has not been investigated in Mexico. OBJECTIVE: To conduct a cost-effectiveness analysis of early and new-generation drug-eluting stents from the perspective of a healthcare provider. METHODS: We conducted a cost-effectiveness analysis of early and new-generation drug-eluting stents in patients with ischemic cardiomyopathy attending a Cardiology Hospital of the Mexican Social Security Institute. The health endpoint used was major acute cardiovascular events prevented. The effectiveness by stent type was obtained from the literature. A retrospective chart review study was conducted to collect cost data on cardiovascular events including seven cost categories. Average and incremental cost-effectiveness ratios were estimated. Deterministic and probabilistic sensitivity analyses were performed to test the robustness of estimates. RESULTS: Incremental cost-effectiveness ratios in base-case were 28,910 and US$ 35,590 for early and new-generation stents, respectively. In an optimal scenario, incremental-cost effectiveness ratio was 24,776 and US$ 25,262 for early and new stents, respectively. Probabilistic sensitivity analysis suggested that 90% of cases were cost-effective when willingness-to-pay was 58,000 and US$ 66,000 for early and new-generation stents, respectively. CONCLUSIONS: The cost-effectiveness ratios of early and new-generation stents were significantly higher than corresponding bare-metal stents.
Asunto(s)
Cardiomiopatías/terapia , Stents Liberadores de Fármacos , Isquemia Miocárdica/terapia , Stents , Angioplastia/economía , Angioplastia/métodos , Cardiomiopatías/economía , Análisis Costo-Beneficio , Stents Liberadores de Fármacos/economía , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Isquemia Miocárdica/economía , Estudios Retrospectivos , Stents/economía , Resultado del TratamientoRESUMEN
Mononuclear stem cells have been studied for their potential in myocardial ischemia. In our previous published article, ReACT(®) phase I/II clinical trial, our results suggest that a certain cell population, promonocytes, directly correlated with the perceived angiogenesis in refractory angina patients. This study is ReACT's clinical update, assessing long-term sustained efficacy. The ReACT phase IIA/B noncontrolled, open-label, clinical trial enrolled 14 patients with refractory angina and viable ischemic myocardium, without ventricular dysfunction, who were not suitable for myocardial revascularization. The procedure consisted of direct myocardial injection of a specific mononuclear cell formulation, with a certain percentage of promonocytes, in a single series of multiple injections (24-90; 0.2 ml each) into specific areas of the left ventricle. Primary endpoints were Canadian Cardiovascular Society Angina Classification (CCSAC) improvement at the 12-month follow-up and ischemic area reduction (scintigraphic analysis) at the 12-month follow-up, in correlation with ReACT's formulation. A recovery index (for patients with more than 1 year follow-up) was created to evaluate CCSAC over time, until April 2011. Almost all patients presented progressive improvement in CCSAC beginning 3 months (p=0.002) postprocedure, which was sustained at the 12-month follow-up (p=0.002), as well as objective myocardium ischemic area reduction at 6 months (decrease of 15%, p<0.024) and 12 months (decrease of 100%, p<0.004) The recovery index (n=10) showed that the patients were graded less than CCSAC 4 for 73.9 ± 24.2% over a median follow-up time of 46.8 months. After characterization, ReACT's promonocyte concentration suggested a positive correlation with CCSAC improvement (r=-0.575, p=0.082). Quality of life (SF-36 questionnaire) improved significantly in almost all domains. Cost-effectiveness analysis showed decrease in angina-related direct costs. Refractory angina patients presented a sustained long-term improvement in CCSAC and myocardium ischemic areas after the procedure. The long-term follow-up and strong improvement in quality of life reinforce effectiveness. Promonocytes may play a key role in myocardial neoangiogenesis. ReACT dramatically decreased direct costs.
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Angina de Pecho/economía , Angina de Pecho/terapia , Análisis Costo-Beneficio , Células Precursoras de Monocitos y Macrófagos/trasplante , Anciano , Angina de Pecho/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico por imagen , Isquemia Miocárdica/economía , Isquemia Miocárdica/terapia , Miocardio/patología , Intervención Coronaria Percutánea , Calidad de Vida , Cintigrafía , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
While a considerable literature has emerged regarding the relationship between the business cycles and mortality rates, relatively little is known regarding how economic fluctuations are related to morbidity. We investigate the relationship between business cycles and heart disease in Mexico using a unique state-level dataset of 512 observations consisting of real GDP and heart disease incidence rates (overall and by age group) from 1995 to 2010. Our study is one of the first to use a state-level panel approach to analyze the relationship between the business cycle and morbidity. Further, the state and year fixed effects employed in our econometric specification reduce possible omitted variable bias. We find a general procyclical, although largely statistically insignificant, contemporaneous relationship. However, an increase in GDP per capita sustained over five years is associated with considerable increases in the incidence rates of ischemic heart disease and hypertension. This procyclical relationship appears strongest in the states with the lowest levels of development and for the oldest age groups. Our results suggest that economic fluctuations may have important lagged effects on heart disease in developing countries.
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Comercio/tendencias , Hipertensión/economía , Isquemia Miocárdica/economía , Adulto , Distribución por Edad , Anciano , Femenino , Humanos , Hipertensión/epidemiología , Masculino , México/epidemiología , Persona de Mediana Edad , Isquemia Miocárdica/epidemiología , Análisis de RegresiónRESUMEN
Although liver transplantation (LT) is a highly effective treatment, it has been considered too costly for publicly funded health systems in many countries with low to medium average incomes. However, with economic growth and improving results, some governments are reconsidering this position. Cost-effectiveness data for LT are limited, especially in perioperative care, and the techniques and costs vary widely between centers without overt differences in outcomes. Anesthesiologists working in new programs find it difficult to determine which modalities are essential, which are needed only in exceptional circumstances, and which may be omitted without effects on outcomes. We investigated key elements of preoperative evaluations, intraoperative management, and early postoperative care that might significantly affect costs in order to develop a best-value approach for new programs in resource-limited health systems. We identified all modalities of care commonly used in anesthesia and perioperative care for adult LT along with their costs. Those considered to be universally accepted as minimum requirements for safe care were excluded from the analysis, and so were those considered to be safe and low-cost, even when evidence of efficacy was lacking. The remaining items were, therefore, those with uncertain or context-restricted value and significant costs. A systematic review of the published evidence, practice surveys, and institutional guidelines was performed, and the evidence was graded and summarized. With respect to costs and benefits, each modality was then cited as strongly recommended, recommended or optional, or no recommendation was made because of insufficient evidence. Sixteen modalities, which included preoperative cardiovascular imaging, venovenous bypass, pulmonary artery catheterization, high-flow fluid warming devices, drug therapies for hemostasis, albumin, cell salvage, anesthetic drugs, personnel (staffing) requirements, and early extubation, were assessed. Only high-flow fluid warming was strongly recommended. The recommended modalities included preoperative echocardiography, cell salvage, tranexamic acid and early extubation. Six others were rated optional, and there was insufficient evidence for 5 modalities. We conclude that some costly techniques and treatments can be omitted without adverse effects on outcomes.
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Producto Interno Bruto/estadística & datos numéricos , Trasplante de Hígado/economía , Modelos Econométricos , Programas Nacionales de Salud/economía , Atención Perioperativa/economía , Anestesia/economía , Anestesia/normas , Anestesia/estadística & datos numéricos , Pérdida de Sangre Quirúrgica/prevención & control , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Análisis Costo-Beneficio , Salud Global , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Hipertensión Pulmonar/economía , Hipertensión Pulmonar/epidemiología , Trasplante de Hígado/normas , Trasplante de Hígado/estadística & datos numéricos , Monitoreo Fisiológico/economía , Monitoreo Fisiológico/normas , Monitoreo Fisiológico/estadística & datos numéricos , Isquemia Miocárdica/economía , Isquemia Miocárdica/epidemiología , Programas Nacionales de Salud/normas , Programas Nacionales de Salud/estadística & datos numéricos , Atención Perioperativa/normas , Atención Perioperativa/estadística & datos numéricos , Calidad de la Atención de Salud/economía , Calidad de la Atención de Salud/estadística & datos numéricosRESUMEN
BACKGROUND: Although stroke and ischemic heart disease (IHD) have several well-established risk factors in common, the extent of global variation in the relative burdens of these forms of vascular disease and reasons for any observed variation are poorly understood. METHODS AND RESULTS: We analyzed mortality and disability-adjusted life-year loss rates from stroke and IHD, as well as national estimates of vascular risk factors that have been developed by the World Health Organization Burden of Disease Program. National income data were derived from World Bank estimates. We used linear regression for univariable analysis and the Cuzick test for trends. Among 192 World Health Organization member countries, stroke mortality rates exceeded IHD rates in 74 countries (39%), and stroke disability-adjusted life-year loss rates exceeded IHD rates in 62 countries (32%). Stroke mortality ranged from 12.7% higher to 27.2% lower than IHD, and stroke disability-adjusted life-year loss rates ranged from 6.2% higher to 10.2% lower than IHD. Stroke burden was disproportionately higher in China, Africa, and South America, whereas IHD burden was higher in the Middle East, North America, Australia, and much of Europe. Lower national income was associated with higher relative mortality (P<0.001) and burden of disease (P=0.001) from stroke. Diabetes mellitus prevalence and mean serum cholesterol were each associated with greater relative burdens from IHD even after adjustment for national income. CONCLUSIONS: There is substantial global variation in the relative burden of stroke compared with IHD. The disproportionate burden from stroke for many lower-income countries suggests that distinct interventions may be required.
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Costo de Enfermedad , Salud Global , Isquemia Miocárdica/economía , Isquemia Miocárdica/epidemiología , Accidente Cerebrovascular/economía , Accidente Cerebrovascular/epidemiología , Organización Mundial de la Salud , África/epidemiología , Australia/epidemiología , China/epidemiología , Europa (Continente)/epidemiología , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Renta/estadística & datos numéricos , Modelos Lineales , Medio Oriente/epidemiología , Isquemia Miocárdica/mortalidad , América del Norte/epidemiología , Prevalencia , Factores de Riesgo , América del Sur/epidemiología , Accidente Cerebrovascular/mortalidadRESUMEN
Background: Tobaceo is the fourth cause of the global burden of disease, accounting for 79.9 million loss of disability-adjusted Ufe years (DALYs) in 2001. In 2002, tobacco-attributable mortality in Chile represented 17 percent of total mortality. Aim: To estimate the direct cost of tobaceo in Ischemic Heart Disease, Chronic Obstructive Pulmonary Disease and Lung Cáncer, explore patients' disposition to answer a health related expenses questionnaire, valídate the instruments used and determine an adequate sample size for an upcoming study. Material and methods: Socio-demographic and health care related variables were investigated among patients attending two publie hospitais for ischemic heart disease, chronic obstructive pulmonary disease and lung cancer, in a cross-sectional study. Costs were estimated using the national publie health insurance price list and market pnces. Tobacco-attributable fraction was then applied to calcúlate the tobacco-attributable cost ofeach disease. Results: The instruments used were validated. The group of lung cáncer patients was smaller due to increased mortality prior to interview. Lung cancer generated the largest total and attríbutable direct costs. The costs in patients with ischemic heart disease were significantly lower Conclusions: There were some difficulties in the application of the questionnaire to register medication use. The sample size needed in a larger study was calculated for each of the three diseases. We recommend that a definitive study addresses tobacco-attributable direct costs related to chronic obstructive pulmonary disease.
Asunto(s)
Anciano , Femenino , Humanos , Masculino , Gastos en Salud/estadística & datos numéricos , Neoplasias Pulmonares/economía , Isquemia Miocárdica/economía , Enfermedad Pulmonar Obstructiva Crónica/economía , Fumar/economía , Chile/epidemiología , Estudios Transversales , Costos de Hospital/estadística & datos numéricos , Neoplasias Pulmonares/mortalidad , Isquemia Miocárdica/epidemiología , Proyectos Piloto , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Años de Vida Ajustados por Calidad de Vida , Encuestas y Cuestionarios , Tamaño de la Muestra , Fumar/epidemiologíaRESUMEN
BACKGROUND: Tobacco is the fourth cause of the global burden of disease, accounting for 79.9 million loss of disability-adjusted life years (DALYs) in 2001. In 2002, tobacco-attributable mortality in Chile represented 17% of total mortality. AIM: To estimate the direct cost of tobacco in Ischemic Heart Disease, Chronic Obstructive Pulmonary Disease and Lung Cancer, explore patients' disposition to answer a health related expenses questionnaire, validate the instruments used and determine an adequate sample size for an upcoming study. MATERIAL AND METHODS: Socio-demographic and health care related variables were investigated among patients attending two public hospitals for ischemic heart disease, chronic obstructive pulmonary disease and lung cancer, in a cross-sectional study. Costs were estimated using the national public health insurance price list and market prices. Tobacco-attributable fraction was then applied to calculate the tobacco-attributable cost of each disease. RESULTS: The instruments used were validated. The group of lung cancer patients was smaller due to increased mortality prior to interview. Lung cancer generated the largest total and attributable direct costs. The costs in patients with ischemic heart disease were significantly lower CONCLUSIONS: There were some difficulties in the application of the questionnaire to register medication use. The sample size needed in a larger study was calculated for each of the three diseases. We recommend that a definitive study addresses tobacco-attributable direct costs related to chronic obstructive pulmonary disease.
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Gastos en Salud/estadística & datos numéricos , Neoplasias Pulmonares/economía , Isquemia Miocárdica/economía , Enfermedad Pulmonar Obstructiva Crónica/economía , Fumar/economía , Anciano , Chile/epidemiología , Estudios Transversales , Femenino , Costos de Hospital/estadística & datos numéricos , Humanos , Neoplasias Pulmonares/mortalidad , Masculino , Isquemia Miocárdica/epidemiología , Proyectos Piloto , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Años de Vida Ajustados por Calidad de Vida , Tamaño de la Muestra , Fumar/epidemiología , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To estimate the annual cost of coronary artery disease (CAD) management in Public Health Care System (SUS) and HMOs values in Brazil. METHODS: Cohort study, including ambulatory patients with proven CAD. Clinic visits, exams, procedures, hospitalizations and medications were considered to estimate direct costs. Values of appointments and exams were obtained from the SUS and the Medical Procedure List (LPM 1999) reimbursement tables. Costs of cardiovascular events were obtained from admissions in public and private hospitals with similar diagnoses-related group classifications in 2002. The price of medications used was the lowest found in the market. RESULTS: The 147 patients (65 +/- 12 years old, 63% men, 69% hypertensive, 35% diabetic and 59% with previous AMI) had an average follow-up of 24 +/- 8 months. The average estimated annual cost per patient was R$ 2,733.00, for the public sector, and R$ 6,788.00, for private and fee-for-service plans. Expenses with medications (R$ 1,154.00) represented 80% and 55% of outpatient costs, and 41% and 17% of total expenses, in public and non-public sectors, respectively. The occurrence of cardiovascular event had a great impact (R$ 4,626.00 vs. R$ 1,312.00, in SUS, and R$ 13,453.00 vs. R$ 1,789.00, for HMOs, p<0.01) on the results. CONCLUSION: The average annual cost of CAD management was high, being the pharmacological treatment the main determinant of public costs. Such estimates may subsidize economical analyses in this area, and foster related healthcare policies.
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Costos de la Atención en Salud/estadística & datos numéricos , Isquemia Miocárdica/economía , Brasil , Estudios de Cohortes , Femenino , Sistemas Prepagos de Salud/economía , Sistemas Prepagos de Salud/normas , Hospitalización/economía , Humanos , Masculino , Isquemia Miocárdica/terapia , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/normas , Sector Privado , Sector PúblicoRESUMEN
OBJETIVO: Estimar o custo anual do manejo da doenca arterial coronária (DAC) em valores do SUS e convênios. MÉTODOS: Estudo de coorte, incluindo pacientes ambulatoriais com DAC comprovada. Considerou-se para estimar custos diretos: consultas, exames, procedimentos, internacões e medicamentos. Valores de consultas e exames foram obtidos da tabela SUS e da Lista de Procedimentos Médicos (LPM). Valores de eventos cardiovasculares foram obtidos de internacões em hospital público e privado com estas classificacões diagnósticas em 2002. O preco dos fármacos utilizado foi o de menor custo no mercado. RESULTADOS: Os 147 pacientes (65n12 anos, 63 por cento homens, 69 por cento hipertensos, 35 por cento diabéticos e 59 por cento com IAM prévio) tiveram acompanhamento médio de 24n8 meses. O custo anual médio estimado por paciente foi de R$ 2.733,00, pelo SUS, e R$ 6.788,00, para convênios. O gasto com medicamentos ($ 1.154,00) representou 80 por cento e 55 por cento dos custos ambulatoriais, e 41 por cento e 17 por cento dos gastos totais, pelo SUS e para convênios, respectivamente. A ocorrência de evento cardiovascular teve grande impacto (R$ 4.626,00 vs. R$ 1.312,00, pelo SUS, e R$ 13.453,00 vs. R$ 1.789,00, para convênios, p<0,01). CONCLUSAO: O custo médio anual do manejo da DAC foi elevado, sendo o tratamento farmacológico o principal determinante dos custos públicos. Essas estimativas podem subsidiar análises econômicas nesta área, sendo úteis para nortear políticas de saúde pública.
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Humanos , Masculino , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Isquemia Miocárdica/economía , Sector Privado/estadística & datos numéricos , Sector Público/estadística & datos numéricos , Brasil , Estudios de Cohortes , Sistemas Prepagos de Salud/economía , Sistemas Prepagos de Salud/normas , Hospitalización/economía , Isquemia Miocárdica/terapia , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/normasRESUMEN
Early postinfarction angina implies an unfavorable prognosis. Most published information on this outcome represents data collected in the prethrombolytic era, in which definitions and populations differed considerably. Our purpose was to evaluate the incidence and importance of recurrent ischemia after administration of thrombolytic therapy. We studied patients enrolled in the Thrombolysis and Angioplasty in Myocardial Infarction studies. Patients were enrolled into 5 studies with similar entry criteria; 552 patients were treated with tissue plasminogen activator (t-PA), 293 were treated with urokinase, and 385 received both thrombolytic agents. Recurrent ischemia was defined as symptoms in association with electrocardiographic changes; reinfarction was defined as a reelevation of creatine kinase myocardial band isoenzyme in an appropriate clinical setting. Both recurrent ischemia and reinfarction occurred in 42 patients (3.4%), recurrent ischemia alone occurred in 226 (18%), whereas neither occurred in 964 (78%). Although baseline characteristics were similar among the 3 groups, in-hospital cardiac events (total 73 deaths, 253 heart failure episodes) were not: in-hospital mortality in patients with reinfarction was 21%; with recurrent ischemia, 11%; and with neither event, 4% (p < 0.0001). The in-hospital heart failure rate of patients with reinfarction was 50%; with recurrent ischemia alone, 31%; and with neither event, 17% (p < 0.0001). As expected, median in-hospital costs were highest in patients with reinfarction ($26,802), intermediate for those with recurrent ischemia alone ($18,422), and lowest in patients with neither event ($15,623). Recurrent myocardial ischemia after thrombolytic therapy is a frequent, important, and expensive adverse clinical outcome, making it a critical target for therapeutic intervention.
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Costos de la Atención en Salud , Infarto del Miocardio/tratamiento farmacológico , Isquemia Miocárdica/epidemiología , Terapia Trombolítica , Anciano , Distribución de Chi-Cuadrado , Femenino , Hospitalización/economía , Humanos , Incidencia , Tiempo de Internación , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Infarto del Miocardio/fisiopatología , Isquemia Miocárdica/economía , Pronóstico , Recurrencia , Estados Unidos , Función VentricularRESUMEN
Embora o ar poluído dos principais centros urbanos e industriais provoque graves problemas para a saúde humana, existem poucas provas epidemiológicas que atestem estes efeitos. Estudos realizados em alguns poucos países demonstram que existe uma associaçäo positiva entre altos índices de poluiçäo e a incidência de determinadas moléstias. Entretanto, para atender os objetivos, julga necessário näo apenas estimar a relaçäo entre mortalidade e poluiçäo do ar, mas também mensurar os custos econômicos relativos à perda de bem-estar. Assim, para formalizar a relaçäo entre poluiçäo do ar e incidência de mortalidade, procura estabelecer relaçöes dose-resposta relativas à poluiçäo do ar e seu impacto sobre as doenças respiratórias e doenças isquêmicas do coraçäo. Procura analisar a correlaçäo entre os dados de poluiçäo do ar e, em seguida, apresenta as funçöes dose-resposta estimadas. Com base nestas funçöes, testa a validade dos coeficientes estimados para a mensuraçäo da incidência de mortalidade nos municípios do Rio de Janeiro, Belo Horizonte e Cubatäo. Apresenta os custos de saúde associados à poluiçäo do ar. Discute os resultados obtidos, comparando-os com estimativas equivalentes determinadas para a poluiçäo hídrica