Tag Archives: cost-effectiveness

Introduction Three important lines of evidence have informed the debate on optimal anticoagulation for people at risk of stroke: Meta-analyses have generally supported the findings from the ENGAGE-AF TIMI-481 and Hokusai-VTE2 trials, in terms of comparable efficacy and reduced bleeding risk with non-vitamin K antagonist oral anticoagulants (NOACs) versus warfarin in patients at risk of stroke, or with acute venous thromboembolism (VTE), respectively.3-8 The randomised Birmingham Atrial Fibrillation Treatment of the Aged Study (BAFTA) trial confirmed the superiority of anticoagulation versus aspirin in elderly patients with atrial fibrillati

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Introduction In many centres, patients stay overnight after their pacing procedure. Most would prefer to get home quicker, and reduced length of stay would result in healthcare savings. Various centres have reported high rates of patient satisfaction,1 and significant cost-savings with day-case pacing,2,3 although this practice is not widespread. A recent survey,4 revealed variation in practice across Europe with many centres routinely mandating a one or two night hospital stay. The safety of day-case pacing was described more than 25 years ago.5,6 Since then, the implant rates of both bradycardia (simple) and more complex devices (cardiac re

Introduction There are 2.3 million people living with coronary heart disease in the UK, which results in a healthcare burden of 1% of all GP and 40% of all accident and emergency (A&E) visits.1 It is estimated that 20–40% of the general population will experience chest pain during their life. Chest pain caused by coronary artery disease has a potentially poor prognosis, emphasising the importance of prompt and accurate diagnosis. Treatments are available to improve symptoms and prolong life, hence, the need for the development of the National Institute for Health and Care Excellence (NICE) guidelines for the diagnosis of chest pain.1 NI

Dr Andrew J Turley (TheJames Cook University Hospital) Despite clear benefits, UK implant rates remain among the lowest in Europe, with wide regional variability seen. This variability is complex and poorly understood.3 One area of inconsistency is between local implementation of international and National Institute for Health and Care Excellence (NICE) guidance. In 2014, NICE released new guidance (TA314) on the use of ICDs and CRT that are significantly more inclusive than previous versions (TA95/TA120).4-6 There is no longer a need for QRS duration, evidence of non-sustained ventricular tachycardia (VT) or electrophysiological studies for

Introduction The increasing burden on healthcare services, combined with effects of austerity, has placed the National Health Service (NHS) under pressure to achieve ever-greater efficiency, while improving the quality of service. An example of the increased demand is that the total number of hospital outpatient appointments in England has increased steadily by more than 3% per annum since 2011.1,2 The government, in the 2010 white paper, set out a redesigned pathway endorsing clinically led services based on more effective dialogue and communication between general practice and secondary care.3 Thus, integration of healthcare services has be

Introduction Heart failure (HF) costs the National Health Service (NHS) £625 million per year and accounts for 5% of all emergency medical hospital admissions in the UK.1,2 Interventions with the potential to reduce admissions and lessen this economic burden are always of clinical interest; however, any such potential for cost-avoidance must always be balanced against the financial cost of the intervention. While there is evidence to suggest that exercise training may reduce emergency admissions in HF,3,4 this research invariably focuses on training that includes a hospital-based component. Though exercising at home may offer a more practic

This supplement is a report from the inaugural meeting of the Cardiometabolic Forum, jointly organised by the British Journal of Cardiology and HEART UK – The Cholesterol Charity. The meeting was held at the Royal Pharmaceutical Society, London, on 24th November 2011. Meeting chairs were Dr Dermot Neely (Royal Victoria Infirmary, Newcastle upon Tyne) for HEART UK, and Dr Henry Purcell (Royal Brompton Hospital, London, and Editor) for BJC. We hope this supplement will provide readers with an independent overview on recent developments in our knowledge of cholesterol metabolism and its implications for clinical practice. Speakers Dermot Neely

Statins represent the cornerstone of treatment in guidelines for lipid management.1 The clinical benefits have been confirmed by meta-analysis of major prospective studies which showed that statins reduced cardiovascular risk by about one fifth per mmol/L reduction in low-density lipoprotein (LDL) cholesterol, largely irrespective of the initial lipid profile, the presence of diabetes, or other presenting characteristics.2,3 More intensive regimens produced further incremental benefit, compared with conventional-dose statin therapy.4 Among patients at higher risk, such as those with pre-existing coronary heart disease (CHD) or with diabetes,

Setting an example The primary care-based heart failure service in Gloucestershire is now four years old and has promising data from its 2006 audit. The audit comprises data from all patients (n=524) with left ventricular systolic dysfunction managed by the service throughout 2006. Results showed all-cause mortality in this high-risk group of only 8.2%, with half of these patients dying at home. In the group of patients who had died during 2006, almost one third had previously discussed and indicated the place they wished to be cared for during the final phase of their illness, with the vast majority opting for home. In over 70% of these case