Economics of presence of heart failure program

J Am Coll Cardiol, 2005; 46:660-666

The Economic Effect of a Tertiary Hospital-Based Heart Failure Program

Douglas Gregory, PhD, David DeNofrio, MD and Marvin A. Konstam, MD

OBJECTIVES: This study was designed to determine the economic effect of a tertiary heart failure (HF) program at an academic medical center.

BACKGROUND: Most hospitals use cross-sectional financial models to analyze the economic contribution of clinical programs for a budget period. We estimated the incremental value of a tertiary hospital HF program on the basis of the longitudinal utilization of a sample of HF patients.

METHODS: The primary data source was a sample of 82 HF patients referred for cardiac transplant evaluation at an academic medical center during calendar years 2000 to 2001. Cumulative recurrent rates of utilization, cost, and reimbursement for hospital services were computed as functions of time using reliability models. The economic contribution of patients transplanted was contrasted with those not transplanted.

RESULTS: Mean hospitalizations and outpatient encounters per patient at the end of the first year of follow-up for those transplanted were 2.1 (95% confidence interval [CI] 1.6 to 2.7) and 11.9 (95% CI 9.2 to 15.4), compared with 1.1 (95% CI 0.8 to 1.6) and 6.0 (95% CI 4.8 to 7.6), respectively, for those not transplanted. Mean revenue and direct cost per patient were $194,470 (95% CI $136,683 to $276,689) and $146,623 (95% CI $96,377 to $233,065), respectively, for transplanted patients and $43,587 (95% CI$28,149 to $67,503) and $33,424 (95% CI $21,584 to $51,760), respectively, for non-transplanted patients. The point estimates of first-year contribution margins per patient for transplanted and non-transplanted patients were $47,847 and $10,163, respectively.

CONCLUSIONS: Newly evaluated patients for cardiac transplantation at an academic medical center generated substantial incident demands for inpatient and outpatient services over a two-year follow-up period. The estimated contribution margin associated with these services was positive. Hospitals without cardiac transplantation that serve high-acuity HF patients may generate favorable long-term contribution margins, on the basis of the results for the non-transplant group.

Pedi cardiology: PICOLO Trial: Dosing of Clopidogrel in Infants and Young Children

Pedi cardiology: PICOLO Trial: Dosing of Clopidogrel in Infants and Young Children

Cath lab: Retinal Emboli after Cardiac Cath (Adult)

Clinical significance of retinal emboli during diagnostic and therapeutic cardiac catheterization in patient with coronary artery disease

Javad Kojuri , Morteza Mehdizadeh , Hamed Rostami and Danial Shahidian

BMC Cardiovascular Disorders 2011, 11:5doi:10.1186/1471-2261-11-5

Published:	21 January 2011

Abstract (provisional)

Background

Cardiac catheterization may cause retinal embolization, a risk factor for cerebrovascular emboli and stroke. We describe the incidence of clinically silent and apparent retinal emboli following diagnostic and interventional coronary catheterization and associated risk factors.

Methods

Three hundred selected patients attending a tertiary referral center for diagnostic and therapeutic cardiac catheterization were studied. Direct retinal examination and examination of the visual field and acuity were done before and after catheterization by a retinal specialist.

Results

There was 5 case of retinal embolus before catheterization, and 19 patients (incidence 6.3%) developed new retinal arteriolar emboli after catheterization. Only 1 patient developed clinically apparent changes in vision. Two conventional risk factors (age and hypertension) were significantly associated with new retinal emboli. The risk of retinal emboli was also significantly associated with operator expertise.

Conclusions

Retinal embolism was found after coronary catheterization in 6.3% of our patients. This finding indicates that the retinal, and possibly the cerebral circulation, may be compromised more frequently than is clinically apparent as a complication of coronary catheterization. Age and hypertension are independent predictors of retinal embolism (clinical trial registrationNCT01157338)

EP: Do ablation lesions grow in size?

Circulation: Arrhythmia and Electrophysiology 2011

Enlargement of Catheter Ablation Lesions in Infant Hearts with Cryothermal Enlargement of Catheter Ablation Lesions in Infant Hearts with Cryothermal Versus Radiofrequency Energy: An Animal Study

1. Paul Khairy*,
2. Peter G. Guerra,
3. Lena Rivard,
4. Jean-François Tanguay,
5. Evelyn Landry,
6. Marie-Claude Guertin,
7. Laurent Macle,
8. Berndard Thibault,
9. Jean-Claude Tardif,
10. Mario Talajic,
11. Denis Roy and
12. Marc Dubuc

Abstract

Background—Radiofrequency catheter ablation in immature hearts has been associated with marked enlargement of lesions over time, with potential for related late adverse events. It remains unknown whether cryothermal ablation lesions display a similar pattern of growth.

Methods and Results—Ablation lesions (n=384) were performed in 32 infant miniature swine in right and left atria, ventricles, and atrioventricular (AV) grooves preselected by a randomized factorial design devised to compare radiofrequency and cryothermal lesions produced by 7-French 4 mm electrode-tip catheters. Animals were sacrificed acutely or at 1, 6, or 12 months according to the randomization scheme. The miniature swine weighed 8.8±1.2 kg and were 63±13 days of age at time of ablation. The minimum temperature during cryoablation was -79.8±3.4°C and the average temperature during radiofrequency ablation was 54.4±5.5°C. On morphometric analyses, no differences in the rate of growth of ablation lesions were noted between the two energy modalities in atria (P=0.44), ventricles (P=0.57), or AV grooves (P=0.69). Lesion volumes increased 3.3-fold in atria [95% confidence interval (CI) 2.3, 4.3, P=0.001] and 2.2-fold in ventricles [95% CI (1.4, 3.0), P<0.0001], p="0.22)." p="">

Conclusions—Ablation lesions produced by cryothermal energy in immature atrial and ventricular myocardium enlarge to a similar extent to radiofrequency ablation. In contrast, AV groove lesion volumes do not increase significantly with either energy modality.

Vaccine to Autism Association...Investigative Review in BMJ

Posted in my other blog

Cath lab: Outcome of ASD created by Transseptal puncture

The Incidence and Long-Term Clinical Outcome of Iatrogenic Atrial Septal Defects Secondary to Transseptal Catheterization with a 12Fr Transseptal Sheath

1. Sheldon M. Singh1*,
2. Pamela S. Douglas2 and
3. Vivek Y. Reddy1

1. ¹ Mount Sinai School of Medicine, New York, NY;
2. ² Duke Clinical Research Institute, Durham,

Abstract

Background—Studies assessing the presence of a residual iatrogenic atrial septal defect (iASD) after transseptal catheterization with 8Fr transseptal sheaths have suggested that the majority of these iASD close within 6 months. However, these studies have been limited by small patient numbers and short follow-up. Additionally, there are a number of novel catheter procedures in interventional cardiology and electrophysiology that employ larger transseptal sheaths. The objective of this study was to assess the incidence of and complications associated with iASD in a large cohort of patients undergoing transseptal catheterization with a 12Fr transseptal sheath.

Methods and Results—253 patients without a pre-existing inter-atrial shunt undergoing WATCHMAN implantation as part of the PROTECT AF study were included in this current study. Patients underwent transesophageal echocardiography (TEE) with echo-contrast immediately post-procedure, 45-days, 6 months, and 12 months. 87% of patients had an iASD immediately post-procedure, the majority of which sealed by 6 months (incidence of iASD - 34% at 45 days, 11% at 6 months, 7% at 12 months). While the majority of iASDs were >3mm in diameter immediately post-procedure, the minority of iASD were >3mm during the follow-up period. Additionally, inter-atrial shunting was predominantly left-to-right when an iASD was present. There was no significant difference in the rate of stroke and/or systemic embolism during the follow up period in patients with or without iASD.

Conclusions—Transseptal catheterization procedures with a large diameter transseptal sheath have a high spontaneous closure rate of iASD, and is not associated with an increased rate of stroke / systemic embolization during long-term follow-up.

• Received July 29, 2010.
• Accepted December 20, 2010.

Cath Lab: Transcatheter techniques to repair Mitral Valve

Review article by Chiam & Ruiz JACC Intrv 2011;4:1-13.
Some current and some futuristic ideas.