Cardiovascular Medicine

5 pages, 126 KB

Open AccessArticle

Medical Costs per QALY of Statins Based on Swiss Medical Board Assumptions

by Michel Romanensa, Isabella Sudanob, Thomas Szucsc and Ansgar Adamsd

Cardiovasc. Med. 2017, 20(4), 96; https://doi.org/10.4414/cvm.2017.00475 - 12 Apr 2017

Cited by 1 | Viewed by 13

Aims: The Swiss Medical Board (SMB) recommends statins in primary care, if risk for coronary death or noncoronary vascular death (SCORE) is above 7.5% in 10 years, because cost per quality-adjusted life years (cost/QALY) is CHF 210,279 over 5 years. Rationale and [...] Read more.

Aims: The Swiss Medical Board (SMB) recommends statins in primary care, if risk for coronary death or noncoronary vascular death (SCORE) is above 7.5% in 10 years, because cost per quality-adjusted life years (cost/QALY) is CHF 210,279 over 5 years. Rationale and effect require further examination. Methods: The SMB cost-efficiency model is applied to 10 rather than 5 years, and for different risk levels for vascular events. These SMB recommendations were studied in a population of 5144 healthy subjects from Germany and Switzerland, in whom the prevalence of advanced carotid atherosclerosis (total plaque area ≥80 mm²: TPA80) was assessed. Results: Cost/QALY was CHF 210,279 in 5 years for SCORE risk of 0.91%. Cost/QALY was CHF 2089 in 10 years for an SCORE risk of 7.5% and was CHF 62,057 for a SCORE risk of 2.5%. At SCORE risk of ≥5% and ≥7.5%, respectively, 86% and 96% of Swiss and 89% and 96% of German subjects aged 40–65 years with TPA80, would be excluded from statin intervention. Conclusion: Cost/QALY of statins is acceptable at a SCORE below 5%. The SMB recommendation to use statins only above the 7.5% SCORE risk threshold cannot be derived from the SMB model. The atherosclerotic burden in primary care is highly prevalent in patients with a SCORE below 5%. Adjustments to lower contemporary risk thresholds for statins should be discussed. Full article

9 pages, 232 KB

Open AccessReview

Going to High Altitude with Heart Disease

by Louis Hofstetter, Urs Scherrer and Stefano F. Rimoldi

Cardiovasc. Med. 2017, 20(4), 87; https://doi.org/10.4414/cvm.2017.00478 - 12 Apr 2017

Cited by 4 | Viewed by 11

Abstract

As a result of ease of travel, a rising number of individuals, including many patients with pre-existing cardiovascular disease, visit high-altitude locations (>2500 m). Exposure to high altitude triggers a series of physiological responses intended to maintain adequate tissue oxygenation. Even in healthy [...] Read more.

As a result of ease of travel, a rising number of individuals, including many patients with pre-existing cardiovascular disease, visit high-altitude locations (>2500 m). Exposure to high altitude triggers a series of physiological responses intended to maintain adequate tissue oxygenation. Even in healthy subjects, there is enormous interindividual variability in these responses, which may be further amplified by environmental factors. These adaptive mechanisms may cause major problems in patients with pre-existing cardiovascular disease who are not able to compensate for such physiological changes. Pre-exposure assessment of patients helps to reduce risk and detect contraindications to high-altitude exposure. The great variability and unpredictability of the adaptive response should encourage physicians counselling such patients to adopt a cautious approach. Here, we briefly review how high-altitude adjustments may interfere with and aggravate/decompensate pre-existing cardiovascular diseases. Moreover, we provide practical recommendations on how to investigate and counsel patients with cardiovascular disease desiring to travel to high-altitude locations. Full article

6 pages, 251 KB

Open AccessReview

Akutes Koronarsyndrom ohne ST-Hebungen: ESC-Richtlinien 2015

by Christian Müllera, Stefan Windeckerb and Marco Roffic

Cardiovasc. Med. 2017, 20(4), 81; https://doi.org/10.4414/cvm.2017.00476 - 12 Apr 2017

Viewed by 13

Abstract

The 2015 ESC guidelines for the diagnosis and management of acute coronary syndrome in patients presenting without ST-segment elevation comprise seven important and clinically-relevant modifications pertaining to the following: (1) a more precise differentiation between acute myocardial infarction and unstable angina pectoris; (2) [...] Read more.

The 2015 ESC guidelines for the diagnosis and management of acute coronary syndrome in patients presenting without ST-segment elevation comprise seven important and clinically-relevant modifications pertaining to the following: (1) a more precise differentiation between acute myocardial infarction and unstable angina pectoris; (2) a simple triage-algorithm enabling us to rapidly “rule-out” or “rule-in” acute myocardial infarction using the high-sensitivity cardiac troponin T or I assay for detecting blood troponin on admission and 1 hour thereafter; (3) duration of cardiac rhythm monitoring; (4) platelet aggregation therapy including its begin and duration; (5) anticoagulation; (6) urgency and vascular approach for coronary angiography und potential coronary revascularization; (7) relevance of consequent and longlasting control of risk factors. As supplement to the 2015 ESC guidelines, for the first time, three additional documents with case-control studies have been elaborated, seeking to illustrate the concrete clinical impact of these new key recommendations based on short clinical case vignettes. Full article

1 pages, 101 KB

Open AccessEditorial

Promotion of Zhihong Yang to Full Professor at the University of Fribourg, Switzerland

by Zhihong Yang

Cardiovasc. Med. 2017, 20(4), 471; https://doi.org/10.4414/cvm.2017.00471 - 12 Apr 2017

Viewed by 8

Abstract

Zhihong Yang studied medicine at Wuhan Tongji Medical University in China.[...] Full article

1 pages, 154 KB

Open AccessEditorial

Prof. Daniel Wagner a éTé Nommé Professeur Ordinaire de L’UNIL

by Thomas F. Lüscher

Cardiovasc. Med. 2017, 20(4), 108; https://doi.org/10.4414/cvm.2017.00470 - 12 Apr 2017

Viewed by 11

Abstract

Portrait du Professeur Daniel Wagner: Etudes de Médecine à Giessen en Allemagne de 1982 à 1988. Formation en Médecine Interne à Bad Nauheim et à l’Hôpital Universitaire de Munich de 1988 à 1992 [...] Full article

3 pages, 366 KB

Open AccessCase Report

The Diagnostic Dilemma of Myocardial Infarction with Unobstructed Coronary Arteries

by Vera Lucia Paiocchia, Laura Anna Leoa, Serena Marcona, Tiziano Moccettia, Francesco Fulvio Faletraa and Chiara Bucciarelli-Duccia

Cardiovasc. Med. 2017, 20(4), 105; https://doi.org/10.4414/cvm.2017.00473 - 12 Apr 2017

Viewed by 12

Abstract

Cardiovascular magnetic resonance imaging (CMR) is increasingly used in modern cardiology to complement the diagnostic work-up of patients with cardiovascular diseases, and to contribute to risk stratification and patient management. We describe a case of a patient in whom CMR was pivotal in [...] Read more.

Cardiovascular magnetic resonance imaging (CMR) is increasingly used in modern cardiology to complement the diagnostic work-up of patients with cardiovascular diseases, and to contribute to risk stratification and patient management. We describe a case of a patient in whom CMR was pivotal in reaching the final diagnosis which carried important implication for patient management and prognosis. A 72-year-old woman presented to the emergency department with intense crushing central chest pain, not radiating to arms/jaw. After clinical assessment, blood tests, echocardiography and angiography, which showed unobstructed coronary arteries, the patient was discharged with a diagnosis of acute myocarditis. She was treated accordingly, and referred for CMR for confirmation of the diagnosis. The CMR revealed myocardial oedema and myocardial scarring. In view of the unobstructed coronary arteries on angiography, this is consistent with a recent myocardial infarction with spontaneous recanalisation. Therefore, the final discharge diagnosis was changed from myocarditis to recent myocardial infarction and the patient’s therapy was modified accordingly (she was started on secondary prevention therapy). This case illustrates the increasing clinical role of CMR in patients with acute coronary syndrome and unobstructed coronary arteries, and its usefulness in reaching the correct diagnosis, which has important implications for clinical management. Full article

3 pages, 294 KB

Open AccessCase Report

Standard Pacemaker Implantation via Femoral Venous Access

by Ulysse Voirola and Haran Burrib

Cardiovasc. Med. 2017, 20(4), 101; https://doi.org/10.4414/cvm.2017.00472 - 12 Apr 2017

Viewed by 12

Abstract

Pacemaker implantation via the femoral vein has been described since the 1980s. This technique is not very well known, but may be useful in some circumstances. We describe a case of a patient with sinus dysfunction without superior venous access, in whom a [...] Read more.

Pacemaker implantation via the femoral vein has been described since the 1980s. This technique is not very well known, but may be useful in some circumstances. We describe a case of a patient with sinus dysfunction without superior venous access, in whom a femoral AAIR pacemaker was successfully implanted with an excellent clinical outcome. Full article

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Cardiovasc. Med., Volume 20, Issue 4 (04 2017) – 7 articles

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