Reduced costs with bisoprolol treatment for heart failure - An economic analysis of the second Cardiac Insufficiency Bisoprolol Study (CIBIS-II)

Background Beta-blockers, used as an adjunctive to diuretics, digoxin and angiotensin converting enzyme inhibitors, improve survival in chronic heart failure. We report a prospectively planned economic analysis of the cost of adjunctive beta-blocker therapy in the second Cardiac Insufficiency BIsoprolol Study (CIBIS II). Methods Resource utilization data (drug therapy, number of hospital admissions, length of hospital stay, ward type) were collected prospectively in all patients in CIBIS . These data were used to determine the additional direct costs incurred, and savings made, with bisoprolol therapy. As well as the cost of the drug, additional costs related to bisoprolol therapy were added to cover the supervision of treatment initiation and titration (four outpatient clinic/office visits). Per them (hospital bed day) costings were carried out for France, Germany and the U.K. Diagnosis related group costings were performed for France and the U.K. Our analyses took the perspective of a third party payer in France and Germany and the National Health Service in the U.K. Results Overall, fewer patients were hospitalized in the bisoprolol group, there were fewer hospital admissions perpatient hospitalized, fewer hospital admissions overall, fewer days spent in hospital and fewer days spent in the most expensive type of ward. As a consequence the cost of care in the bisoprolol group was 5-10% less in all three countries, in the per them analysis, even taking into account the cost of bisoprolol and the extra initiation/up-titration visits. The cost per patient treated in the placebo and bisoprolol groups was FF35 009 vs FF31 762 in France, DM11 563 vs DM10 784 in Germany and pound 4987 vs pound 4722 in the U.K. The diagnosis related group analysis gave similar results. Interpretation Not only did bisoprolol increase survival and reduce hospital admissions in CIBIS II, it also cut the cost of care in so doing. This `win-win' situation of positive health benefits associated with cost savings is Favourable from the point of view of both the patient and health care systems. These findings add further support for the use of beta-blockers in chronic heart failure

Quantification of wave propagation velocity from a colour M-mode Doppler image : implementation and analysis of different methods

Diastolic dysfunction of the left ventricle is a complex sequence of multiple interrelated events, and if is still difficult to understand diagnose and treat the various abnormalities of diastolic filling. Unfortunately, the standard Doppler echocardiographic modes, used to examine the different diastolic filling patterns of the left ventricle, only provide restricted information on diastolic function. in this paper an automated tool is developed to obtain information about the shape of the spatiotemporal filling pattern. The assessment is based on published method of Brun et al, Takatsuji et al, Stugaard et al and Greenberg et al. The ventricular filling of a group of 11 hypertensive patients, before and after treatment with the ACE - inhibitor Perindopril, is studied Stugaards as well as Greenbergs method show a significant decrease of the wave propagation velocity oft he E-wave after treatment Our first results also indicate differences between the methods in analysing the first or second phase of the early filling wave

A numerical and experimental study on viscoelastic damping of a 3D structure

Structural vibrations often cause problems in high precision instruments, which may be solved by introducing passive damping. In this paper, different ways of introducing passive damping via viscoelastic materials (VEM) are discussed. Discrete damping elements and constrained layer (CL) configurations are selected and used to efficiently damp an open aluminum box. For the constrained layer configurations, a distinction is made between full and partial coverage of the structure. The steady-state dynamics of the box are simulated using a finite element (FE) model, which includes frequency dependent VEM properties. This model is used to find a design that possesses high damping while taking into account design constraints. The simulation results are experimentally validated using both modal parameters and frequency response functions (FRFs). For the computation of model based FRFs, a new method based on Interpolated Modal Parameter Superposition (IMPS) is proposed. Model based results and experimental results show good resemblance, even without updating the model with deviations in the realized structure. The local dampers add most damping to a limited number of modes. Partially covering the box with CL dampers is found to be more effective than full coverage of the structure with the same mass addition

A numerical and experimental study on passive damping of a 3D structure using viscoelastic materials

Structural vibrations often cause problems in high precision instruments, which may be solved by introducing passive damping. In this paper, different ways of introducing passive damping via viscoelastic materials (VEM) are discussed. Discrete damping elements and constrained layer (CL) configurations are selected and used to efficiently damp an open aluminum box. The steady-state dynamics of the box, including frequency dependent VEM properties, are simulated using a finite element (FE) model. This model is used to find a design that introduces high damping while taking into account design constraints. The simulation results are experimentally validated using both modal parameters and frequency response functions (FRFs). For the computation of model based FRFs, a new method based on modal superposition and frequency interpolation of modal parameters is proposed. Model based results and experimental results show good resemblance, even without updating the model with deviations in the realized structure

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Effects of ibopamine on renal haemodynamics in patients with severe congestive heart failure

The effects of a single dose of ibopamine on renal haemodynamics, sodium excretion, blood pressure (BP) and heart rate (HR) were investigated in 10 patients (aged 52-82 years) with severe congestive heart failure (CHF) who were in NYHA class IV. All patients used ACE inhibitors, digoxin and diuretics. After determining baseline values, ibopamine 100 mg was administered.Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured simultaneously using radio pharmaceuticals. An increase in GFR and ERPF was observed during 3 and 2 h, with a maximum of 15 and 11%, respectively. The ratio GFR/ERPF representing the filtration fraction (FF) was markedly elevated at baseline, 34%, and remained unchanged. No clinically significant increase of sodium excretion was found. No changes in blood pressure, heart rate, plasma renin activity (PRA) and aldosterone or norepinephrine were observed. We conclude that ibopamine increases both ERPF and GFR in patients with severe CHF, possibly as a consequence of both inotropic cardiac and specific renal effects with equal preglomerular and postglomerular vasodilation. The lack of the presumed fall in FF may be the consequence of the expected DA1-induced renal vasodilation, partially reversed by the alpha adrenergic properties of ibopamine for this dose. Ibopamine caused no clinically significant natriuresis in these salt-depleted patients. No changes in PRA, aldosterone and catecholamines were found