Measuring the health-related Sustainable Development Goals in 188 countries : a baseline analysis from the Global Burden of Disease Study 2015

Background In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). Methods We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. Findings In 2015, the median health-related SDG index was 59.3 (95% uncertainty interval 56.8-61.8) and varied widely by country, ranging from 85.5 (84.2-86.5) in Iceland to 20.4 (15.4-24.9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r(2) = 0.88) and the MDG index (r(2) = 0.2), whereas the non-MDG index had a weaker relation with SDI (r(2) = 0.79). Between 2000 and 2015, the health-related SDG index improved by a median of 7.9 (IQR 5.0-10.4), and gains on the MDG index (a median change of 10.0 [6.7-13.1]) exceeded that of the non-MDG index (a median change of 5.5 [2.1-8.9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. Interpretation GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs.Peer reviewe

PO06-23: Medtronic carelink express device usage in midsize emergency department

Introduction: Patients with Medtronic devices presenting to emergency department (ED) need interrogation of the device. The manual interrogation via the on-call nurse or the representative may take time. This time will increase the cost per case and the overflow in the ED preventing newcomers to be seen in a timely fashion. CareLink express (CLE) technology allows an automatic interrogation in the ED that will be interpreted instantly electronically. The time and cost using CLE is evaluated in a midsize ED. Methods: During a 10-month period there were 125 consecutive patients with Medtronic devices (69.5± 20 years old, 61.3% males) who came to ED for interrogation. The cost and length of stay in ED was compared between two groups. The study group includes patients with CLE (46 patients); the control group includes patients without CLE (79 patients). Endpoints measured were length of stay in ED in minutes and estimated cost of stay ($6/min cost factor is used according to National Database of Hospitals 2010). Results: The demographics of the two groups were similar (67.9±2.48 vs. 70.3±1.83 years old; and 67.4$1093.4±58.14) vs. the control group ($1378.7±55.16) (P=0.001). There was no difference in the interrogation findings (76.1% vs. 64.6% normal) and defibrilator shocks (10.9% vs. 8.9%). The inpatient admission decision was the same in both groups (43.5% vs. 53.2%). As expected, there was a trend of fewer patients in the CLE group that had reprogramming of the device (2.2% vs. 13.9%) (P = 0.055). Conclusions: CareLink Express facilitates a shorter length of stay in the ED for patients with Medtronic devices and less cost to the patient without affecting the disposition decision

Medtronic CareLink Express device usage in midsize emergency department

Conclusion: CareLink Express facilitates a shorter length of stay in ED with number of patients needed to make it cost-effective is at least 19 patients per year in facilities without an on-call pacewatch nurse, and 12 patients per year in facilities with an on-call pacewatch nurse

Missed opportunity for timely intervention to prevent a life-threatening event

The LifeVest wearable cardioverter-defibrillator (WCD; ZOLL Medical Corp, Pittsburgh, PA) has been approved by the US Food and Drug Administration for use with select patients who are at risk for sudden cardiac arrest. However, one of its lesser-emphasized features is the ability to detect asystole and severe bradycardic events that can help in the early identification of patients in need of pacing. Here, we describe the case of a 71-year-old man who had advanced atrioventricular (AV) block lasting 10 seconds documented by the LifeVest system and discuss some of the features of the LifeVest that can be optimized to expedite the care of these patients