Healthcare resource utilization

Background: Treatment resistant depression (TRD) is diagnosed when patients experiencing a major depressive episode fail to respond to ≥2 treatments. Along with substantial indirect costs, patients with TRD have higher healthcare resource utilization (HCRU) than other patients with depression. However, research on the economic impact of this HCRU, and differences according to response to treatment, is lacking. Methods: This multicenter, observational study documented HCRU among patients with TRD in European clinical practice initiating new antidepressant treatments. Data regarding access to outpatient consultations and other healthcare resources for the first 6 months, collected using a questionnaire, were analyzed qualitatively according to response and remission status. The economic impact of HCRU, estimated using European costing data, was analyzed quantitatively. Results: Among 411 patients, average HCRU was higher in non-responders, attending five times more general practitioner (GP) consultations and spending longer in hospital (1.7 versus 1.1 days) than responders. Greater differences were observed according to remission status, with non-remitters attending seven times more GP consultations and spending approximately three times longer in hospital (1.7 versus 0.6 days) than remitters. Consequently, the estimated economic impacts of non-responders and non-remitters were significantly greater than those of responders and remitters, respectively. Limitations: Key limitations are small cohort size, absence of control groups and generalizability to different healthcare systems. Conclusion: Patients with TRD, particularly those not achieving remission, have considerable HCRU, with associated economic impact. The costs of unmet TRD treatment needs are thus substantial, and treatment success is fundamental to reduce individual needs and societal costs.publishersversionpublishe

Ранние результаты после шунтирования коронарных артерий у пациентов с выраженной ишемической дисфункцией левого желудочка

Introduction. The number of patients with severe ischemic left ventricular dysfunction (ILVD), who undergo coronary artery bypass, increasing each year. ILVD is an established risk factor for mortality in patients after myocardial revascularization during the early and late postoperative periods.Aim of study. To evaluate the early results of surgical myocardial revascularization in patients with coronary artery disease (CAD) and severe ILVD.Material and methods. The study included 149 patients with coronary artery disease with severe left ventricular dysfunction (ejection fraction (EF) ≤39%), operated from January 2002 to December 2018. different variables were assessed (pre- and postoperative), including LV ejection fraction and end systolic volume index (ESVI).Results. The average age of the patients was 59.36±8.97 years (from 30 to 78 years), 93% of the patients were men. In 28 patients (19%), ILVD developed against the background of myocardial infarction (MI) and in 121 (81%) due to ischemic cardiomyopathy (ICMP) with a history of myocardial infarction. The mean EF before surgery was 36.64±3.17 (from 21 to 39%). In the postoperative period, there was an increase in EF, which averaged 44.92±4.92 (from 36 to 59%) (p value <0.001). The mean LV ESVI before surgery was 60.23±11.52 ml/m2. In the immediate postoperative period ESVI decreased to 46.26±12.40 ml/m2 (the value of p<0.001). The average number of bypass coronary arteries in one patient was 3.9±0.87. There was also a decrease in the degree of mitral regurgitation in most patients after coronary artery bypass grafting (CABG) (p value <0.001). Hospital mortality was 2% (3 patients).Conclusion. Coronary artery bypass grafting in patients with severe ischemic left ventricular dysfunction can be performed with low mortality. Surgical myocardial revascularization can be considered a safe and effective operation for patients with coronary artery disease with a satisfactory condition of the distal coronary arteries, low ejection fraction, and with a predominance of viable myocardium.Введение. Количество пациентов с тяжелой ишемической левожелудочковой дисфункцией (ИЛЖД), которым выполняют шунтирование коронарных артерий, увеличивается из года в год. ИЛЖД является установленным фактором риска смертельных исходов у больных после реваскуляризации миокарда в раннем и отдаленном послеоперационном периодах.Цель исследования. Оценить ранние результаты хирургической реваскуляризации миокарда у больных ишемической болезнью сердца (ИБС) и выраженной ИЛЖД.Материал и методы. В исследования включены 149 больных ИБС с тяжелым нарушением функции левого желудочка — ЛЖ (фракция выброса (ФВ) ≤39%), оперированных с января 2002 г. по декабрь 2018 г. Были оценены различные переменные величины (предоперационные и послеоперационные), включая такие, как ФВ ЛЖ и индекс конечно систолического объема (ИКСО).Результаты. Средний возраст пациентов составил 59,36±8,97 года (от 30 до 78 лет), 93% пациентов были мужчинами. У 28 пациентов (19%) ИЛЖД развилась на фоне острого инфаркта миокарда (ОИМ) и у 121 (81%) — вследствие ишемической кардиомиопатии (ИКМП) с перенесенным инфарктом миокарда в анамнезе. Среднее значение ФВ ЛЖ перед операцией составило 36,64±3,17 (от 21 до 39%). В послеоперационном периоде отмечалось увеличение ФВ ЛЖ, которое составило в среднем 44,92±4,92 (от 36 до 59%) (значение р<0,001). Среднее значение ИКСО ЛЖ до операции составило 60,23±11,52 мл/м2. В ближайшем послеоперационном периоде отмечено снижение ИКСО до 46,26±12,40 мл/м2 (значение р<0,001). Среднее количество шунтированных коронарных артерий у одного пациента составило 3,9±0,87. Наблюдалось также уменьшение степени митральной регургитации у большинства больных после коронарного шунтирования (КШ) (значение р<0,001). Госпитальная летальность составила 2% (3 пациента).Выводы. Коронарное шунтирование у пациентов с тяжелой формой ишемической левожелудочковой дисфункции может быть выполнено с низкой летальностью. Хирургическую реваскуляризацию миокарда можно считать безопасной и эффективной операцией для пациентов с ишемической болезнью сердца с удовлетворительным состоянием дистальных отделов коронарных артерий, низкой фракцией выброса и с преобладанием жизнеспособного миокарда

POSB236 X-Linked Retinitis Pigmentosa Negatively Affects Patients’ Work Status, Independence, and Quality of Life: Results from the Cross-Sectional EXPLORE XLRP 1 Physician Survey

Objectives: To understand the impact of X-linked retinitis pigmentosa (XLRP) on patients’ working status, independence/autonomy, and quality of life (QoL

POSA249 Diagnostic Pathways, Genetic Testing, and Impact of COVID-19 on Patients in Europe with X-Linked Retinitis Pigmentosa: Results from the Cross-Sectional Explore XLRP 1 Physician Survey

Objectives: To understand the pathways by which European patients with X-linked retinitis pigmentosa (XLRP) arrive at retina specialists (RS) and geneticists for diagnosis, and the impact of COVID-19 on patient management. Methods: The EXPLORE XLRP 1 survey interviewed RS (n=20) and geneticists (n=5) in France, Germany, Italy, Spain, and the United Kingdom (UK) to record information about healthcare pathways and diagnostic approaches for patients with XLRP (n=80). Results: Patients (mostly male [91%] and aged 18–40 years [57%]) experienced an average time of 4 years between XLRP symptoms and diagnosis. In France, Spain, and Italy, patient pathways are linear most patients see RS/geneticists by ophthalmologist referral. In Germany and the UK, patients see RS/geneticists through multiple routes, also including general practitioner and optometrist referrals. Genetic testing was used as part of XLRP diagnosis in 78% of patients. Genetic testing usually took >6 weeks to receive results, and some patients waited up to 6 months. Genetic testing was fully reimbursed for most patients, except those in Spain, where patients largely incurred the full cost. In the UK, testing costs were co-paid by 14% of patients. Despite barriers to genetic testing (e.g., costs, long waiting times for results), physicians agreed that genotypic diagnosis is helpful to predict disease progression and to enable patient involvement in clinical trials. The COVID-19 pandemic reduced the frequency of in-person clinic visits, but some physicians utilized tele-consultation and remote patient management. Conclusions: The pathways by which patients with XLRP in Europe visit RS and geneticists are complex, lengthy, and vary considerably by country. This survey reported high usage of genetic testing to confirm XLRP diagnosis, but long waiting times for test results accounts for incomplete uptake, especially among older patients. Tele-consultations and remote management have emerged as potential solutions for monitoring patients during the COVID-19 pandemic

Clinical and biochemical features of the patient status in early postoperaive period after coronary artery bypass surgery (review)

In cardiac surgery practice has accumulated a great experience and made significant progress in the performance of CABG. At the same time the emergence of a number of specific cases of postoperative complications (atrial fibrillation, renal failure, disorders of acid-base balance and fluid and electrolyte balance) associated with the need to use artificial blood circulation. In this regard, currently the most promising methods of improving the technology of CS recognized the operation on a beating heart, and the use of parallel normothermic perfusion. The analysis of literature indicates only a single study of comparative clinical effectiveness of these methods compared with traditional surgery with cardiopulmonary bypass with cardioplegia

Early Results After Coronary Artery Bypass Grafting in Patients With Severe Ischemic Left Ventricular Dysfunction

Introduction. The number of patients with severe ischemic left ventricular dysfunction (ILVD), who undergo coronary artery bypass, increasing each year. ILVD is an established risk factor for mortality in patients after myocardial revascularization during the early and late postoperative periods.Aim of study. To evaluate the early results of surgical myocardial revascularization in patients with coronary artery disease (CAD) and severe ILVD.Material and methods. The study included 149 patients with coronary artery disease with severe left ventricular dysfunction (ejection fraction (EF) ≤39%), operated from January 2002 to December 2018. different variables were assessed (pre- and postoperative), including LV ejection fraction and end systolic volume index (ESVI).Results. The average age of the patients was 59.36±8.97 years (from 30 to 78 years), 93% of the patients were men. In 28 patients (19%), ILVD developed against the background of myocardial infarction (MI) and in 121 (81%) due to ischemic cardiomyopathy (ICMP) with a history of myocardial infarction. The mean EF before surgery was 36.64±3.17 (from 21 to 39%). In the postoperative period, there was an increase in EF, which averaged 44.92±4.92 (from 36 to 59%) (p value <0.001). The mean LV ESVI before surgery was 60.23±11.52 ml/m2. In the immediate postoperative period ESVI decreased to 46.26±12.40 ml/m2 (the value of p<0.001). The average number of bypass coronary arteries in one patient was 3.9±0.87. There was also a decrease in the degree of mitral regurgitation in most patients after coronary artery bypass grafting (CABG) (p value <0.001). Hospital mortality was 2% (3 patients).Conclusion. Coronary artery bypass grafting in patients with severe ischemic left ventricular dysfunction can be performed with low mortality. Surgical myocardial revascularization can be considered a safe and effective operation for patients with coronary artery disease with a satisfactory condition of the distal coronary arteries, low ejection fraction, and with a predominance of viable myocardium

Real-world evidence from a European cohort study of patients with treatment resistant depression: Healthcare resource utilization

Background: Treatment resistant depression (TRD) is diagnosed when patients experiencing a major depressive episode fail to respond to ≥2 treatments. Along with substantial indirect costs, patients with TRD have higher healthcare resource utilization (HCRU) than other patients with depression. However, research on the economic impact of this HCRU, and differences according to response to treatment, is lacking. Methods: This multicenter, observational study documented HCRU among patients with TRD in European clinical practice initiating new antidepressant treatments. Data regarding access to outpatient consultations and other healthcare resources for the first 6 months, collected using a questionnaire, were analyzed qualitatively according to response and remission status. The economic impact of HCRU, estimated using European costing data, was analyzed quantitatively. Results: Among 411 patients, average HCRU was higher in non-responders, attending five times more general practitioner (GP) consultations and spending longer in hospital (1.7 versus 1.1 days) than responders. Greater differences were observed according to remission status, with non-remitters attending seven times more GP consultations and spending approximately three times longer in hospital (1.7 versus 0.6 days) than remitters. Consequently, the estimated economic impacts of non-responders and non-remitters were significantly greater than those of responders and remitters, respectively. Limitations: Key limitations are small cohort size, absence of control groups and generalizability to different healthcare systems. Conclusion: Patients with TRD, particularly those not achieving remission, have considerable HCRU, with associated economic impact. The costs of unmet TRD treatment needs are thus substantial, and treatment success is fundamental to reduce individual needs and societal costs

Real-world evidence from a european cohort study of patients with treatment resistant depression: healthcare resource utilization

Background: treatment resistant depression (TRD) is diagnosed when patients experiencing a major depressive episode fail to respond to ≥2 treatments. Along with substantial indirect costs, patients with TRD have higher healthcare resource utilization (HCRU) than other patients with depression. However, research on the economic impact of this HCRU, and differences according to response to treatment, is lacking. Methods: this multicenter, observational study documented HCRU among patients with TRD in European clinical practice initiating new antidepressant treatments. Data regarding access to outpatient consultations and other healthcare resources for the first 6 months, collected using a questionnaire, were analyzed qualitatively according to response and remission status. The economic impact of HCRU, estimated using European costing data, was analyzed quantitatively. Results: among 411 patients, average HCRU was higher in non-responders, attending five times more general practitioner (GP) consultations and spending longer in hospital (1.7 versus 1.1 days) than responders. Greater differences were observed according to remission status, with non-remitters attending seven times more GP consultations and spending approximately three times longer in hospital (1.7 versus 0.6 days) than remitters. Consequently, the estimated economic impacts of non-responders and non-remitters were significantly greater than those of responders and remitters, respectively. Limitations: key limitations are small cohort size, absence of control groups and generalizability to different healthcare systems. Conclusion: patients with TRD, particularly those not achieving remission, have considerable HCRU, with associated economic impact. The costs of unmet TRD treatment needs are thus substantial, and treatment success is fundamental to reduce individual needs and societal costs

Острое повреждение миокарда, выявленное с помощью перфузионной однофотонной эмиссионной компьютерной томографии, синхронизированной с ЭКГ, у пациентки в полиморбидном состоянии

A case of acute focal myocardial injury in a polymorbid female patient with intact coronary arteries according to direct coronary angiography is reported. Acute focal myocardial injury was detected by ECG-synchronized  perfusion single-photon emission computed tomogra-phy (SPECT) of the  myocardium, and confirmed by the results of postmortem examination. The article also discusses the possibility of using perfusion SPECT to diagnose acute focal changes against the background of focal inflammatory myocardial infiltration. Представлен случай острого очагового повреждения миокарда у полиморбидной пациентки с интактными коронарными артериями по данным прямой  коронароангиографии. Острое очаговое повреждение миокарда было выявлено с помощью перфузионной однофотонной эмиссионной компьютерной томографии (ОФЭКТ) миокарда, синхронизированной с электрокардиографией, и подтверждено результатами патологоанатомического вскрытия. В статье также обсуждается возможность с помощью перфузионной ОФЭКТ диагностировать острые очаговые изменения на фоне очаговой воспалительной инфильтрации миокарда.