Cost-effectiveness of a European ST-segment elevation myocardial infarction network: results from the Catalan Codi Infart network

Objectives: To evaluate the cost-effectiveness of the ST-segment elevation myocardial infarction (STEMI) network of Catalonia (Codi Infart). Design Cost-utility analysis. Setting: The analysis was from the Catalonian Autonomous Community in Spain, with a population of about 7.5 million people. Participants: Patients with STEMI treated within the autonomous community of Catalonia (Spain) included in the IAM CAT II-IV and Codi Infart registries. Outcome measures costs included hospitalisation, procedures and additional personnel and were obtained according to the reperfusion strategy. Clinical outcomes were defined as 30-day avoided mortality and quality-adjusted life-years (QALYs), before (N=356) and after network implementation (N=2140). Results: A substitution effect and a technology effect were observed; aggregate costs increased by 2.6%. The substitution effect resulted from increased use of primary coronary angioplasty, a relatively expensive procedure and a decrease in fibrinolysis. Primary coronary angioplasty increased from 31% to 89% with the network, and fibrinolysis decreased from 37% to 3%. Rescue coronary angioplasty declined from 11% to 4%, and no reperfusion from 21% to 4%. The technological effect was related to improvements in the percutaneous coronary intervention procedure that increased efficiency, reducing the average length of the hospital stay. Mean costs per patient decreased from 8306 to 7874 for patients with primary coronary angioplasty. Clinical outcomes in patients treated with primary coronary angioplasty did not change significantly, although 30-day mortality decreased from 7.5% to 5.6%. The incremental cost-effectiveness ratio resulted in an extra cost of 4355 per life saved (30-day mortality) and 495 per QALY. Below a cost threshold of 30,000, results were sensitive to variations in costs and outcomes. Conclusions: The Catalan STEMI network (Codi Infart) is cost-efficient. Further studies are needed in geopolitical different scenarios

The extension of smoke-free areas and acute myocardial infarction mortality: before and after study

Objectives: Recent studies suggest that comprehensive smoking regulations to decrease exposure to second-hand smoke reduce the rates of acute myocardial infarction (AMI). The objective of this paper is to analyse if deaths due to AMI in Spain declined after smoking prevention legislation came into force in January 2006. Design: Information was collected on deaths registered by the Instituto Nacional de Estadistica for 2004e2007. Age- and sex-specific annual AMI mortality rates with 95% CIs were estimated, as well as age-adjusted annual AMI mortality rates by sex. Annual relative risks of death from AMI were estimated with an age-standardised Poisson regression model. Results: Adjusted AMI mortality rates in 2004 and 2005 are similar, but in 2006 they show a 9% decline for men and a 8.7% decline for women, especially among those over 64 years of age. In 2007 there is a slower rate of decline, which reaches statistical significance for men (-4.8%) but not for women (-4%). The annual relative risk of AMI death decreased in both sexes (p<0.001) from 1 to 0.90 in 2006, and to 0.86 in 2007. Conclusion: The extension of smoke-free regulations in Spain was associated with a reduction in AMI mortality, especially among the elderly. Although other factors may have played a role, this pattern suggests a likely influence of the reduction in population exposure to second-hand smoke on AMI deaths

Las caídas en los mayores de 65 años: conocer para actuar

ObjetivoDar a conocer la prevalencia declarada de caídas y analizar los factores de riesgo asociados a ellas en la población no institucionalizada >65 años en CataluñaMaterial y métodoDatos de la Encuesta de Salud de Cataluña de 2002. Se analizan las respuestas de la población > 65 años (542 varones y 665 mujeres). Se ha llevado a cabo un análisis multivariable de regresión logística de la declaración de haber sufrido alguna caída en función de la edad, el sexo, el nivel de estudios, la clase social y la presencia de enfermedades crónicas y discapacidadesMediciones y resultados principalesEl 17,9% de la población > 65 años declara haber padecido alguna caída en el transcurso de los últimos 12 meses. La frecuencia de caídas aumenta con la edad. Ser mujer, haber cursado estudios universitarios, padecer 3 o más enfermedades crónicas y 2 discapacidades incrementan la probabilidad de sufrir caídas. En relación con la Encuesta de Salud del año 1994, aumenta significativamente la proporción de población anciana que declara haber sufrido alguna caídaConclusionesAunque es necesario avanzar enel conocimiento sobre los factores de riesgo y las posibles intervenciones para prevenir y disminuir las caídas en los ancianos, un abordaje multifactorial e intersectorial parece el más adecuadoObjectiveTo study the prevalence of falls and to analyze the associated factors in non institutionalized population aged 65 or older in CataloniaMaterial and methodsData were collected from the 2002 Health Survey of Catalonia. Information on self reportedfalls according age, sex, educational level, social class, suffering chronic diseases and disabilities in people aged 65 or older (542 men and 665 women) was analyzed. Multivariate logistic analysis was appliedMeasurements and main results17,9% of the population aged 65 or older reported falls during the last twelve months. The frequency increases with ageing.To be women, to have university studies, having three or more chronic diseases and two disabilities is associated to a high risk of falling. Comparing 1994 and 2002 Health Surveys of Catalonia, the proportion of elderly people who reported falls has significantly increasedConclusionsAlthough it is necessary to advance on the knowledge of the risk factors and interventionsaddressed to prevent and reduce the occurrence of falls in the elderly people, a multifactorial and intersectorial approach seems the most adequat

Impact of a partial smoke-free legislation on myocardial infarction incidence, mortality and case-fatality in a population-based registry: the REGICOR study

Coronary heart disease (CHD) is the leading cause of death, and smoking its strongest modifiable risk factor. Our aim was to determine the impact of the Spanish 2006 partial smoke-free legislation on acute myocardial infarction (AMI) incidence, hospitalization and mortality rates, and 28-day case-fatality in Girona, Spain. Using a population-based registry (the REGICOR Study), we compared population incidence, hospitalization, and mortality rates, and 28-day case-fatality in the pre- and post-ban periods (2002–2005 and 2006–2008, respectively) by binomial regression analysis adjusted for confounding factors. We also analyzed the ban's impact on the outcomes of interest using the AMI definitions of the American Heart Association (AHA)/European Society of Cardiology (ESC) and the World Health Organization (WHO)-Monitoring trends and determinants in cardiovascular diseases (MONICA). In the post-ban period, AMI incidence and mortality rates significantly decreased (relative risk [RR] = 0.89; 95% confidence interval [CI] = 0.81–0.97 and RR = 0.82; 95% CI = 0.71–0.94, respectively). Incidence and mortality rates decreased in both sexes, especially in women, and in people aged 65–74 years. Former and non-smokers (passive smokers) showed diminished incidence rates. Implementation of the ban was not associated with AMI case-fatality. Models tended to be more significant with the WHO-MONICA than with the AHA/ESC definition. The 2006 Spanish partial smoke-free legislation was associated with a decrease in population AMI incidence and mortality, particularly in women, in people aged 65–74 years, and in passive smokers. These results clarify the association between AMI mortality and the enactment of a partial smoke-free legislation and reinforce the effectiveness of smoking regulations in preventing CHD