Cardiology News / Recent Literature Review / First Quarter 2016

Abstract

ACC 65^th Annual Session: Chicago, 2-4/4/2016

HRS 37^th Annual Meeting: San Francisco, 4-7/5/16

CardioStim/Europace: Nice, 8-11/6/2016

Euro PCR: Paris, 17-20/5/2016

ESC Meeting: Rome, 27-31/8/2016

HCS Panhellenic Congress: Athens, 20-22/10/2016

TCT Conference: Washington, DC, 29/10-2/11/2016

AHA Scientific Sessions: New Orleans, 12-16/11/2016

Exercise-Based Cardiac Rehabilitation Reduces the Risk of Cardiovascular (CV) Mortality and Hospital Admission and Improves Quality of Life in Patients With Coronary Heart Disease

Meta-analyses of exercise-based cardiac rehabilitation (CR) studies (n=63) comprising 14,486 participants with median follow-up of 1 year indicated that CR led to a reduction in CV mortality (relative risk - RR: 0.74) and the risk of hospital admissions (RR: 0.82). There was no significant effect on mortality, MI, or revascularization. The majority of studies (14 of 20) showed higher levels of health-related quality of life following exercise-based CR compared with control subjects (Anderson L et al, J Am Coll Cardiol 2016;67:1-12).

Coronary CT Angiography (CCTA), Applied Early in Suspected Acute Coronary Syndrome (ACS), is Safe and Associated with Less Outpatient Testing and Lower Costs. However, in the Era of hs-Troponins, it does not Identify more Patients with Significant CAD Requiring Coronary Revascularization, nor does it Shorten Hospital Stay or Allow for More Immediate Discharge from the Emergency Department (ED)

Among 500 patients (age 54 ± 10 years, 47% women) with symptoms suggestive of an ACS at the ED, there was no difference in the primary endpoint (22 or 9% patients underwent coronary revascularization within 30 days in the CCTA group and 17 or 7% in the standard care group; p= NS). Discharge from the ED was not more frequent after CCTA (65% vs 59%, p= NS), and length of stay was similar (6.3 h in both groups; p= NS). The CCTA group had lower direct medical costs (€337 vs €511, p< 0.01) and less outpatient testing (10 or 4% vs 26 or 10%, p< 0.01). There was no difference in incidence of undetected ACS (Dedic A et al, J Am Coll Cardiol 2016; 67:16-26).

Cost-Effectiveness of Transcatheter Aortic Valve Implantation (TAVI) with a Self-Expanding Prosthesis vs Surgical Aortic Valve Replacement (AVR): TAVI in Patients at High Risk for Complications with AVR Provides Important Incremental Health Benefits at Reasonable Incremental Costs and is an Acceptable Value for the U.S. Health Care System

Relative to AVR, TAVI reduced initial length of stay an average of 4.4 days, decreased the need for rehabilitation services at discharge, and resulted in superior 1-month quality of life. Index admission and projected lifetime costs were higher with TAVI than with AVR (differences $11,260 and $17,849 per patient, respectively), whereas TAVI was projected to provide a lifetime gain of 0.32 quality-adjusted life-years (QALY; 0.41 LY) with 3% discounting. Lifetime incremental cost-effectiveness ratios were $55,090 per QALY gained and $43,114 per LY gained. N.B.: mean procedure costs: $37,920 for TAVI & $14,258 for AVR (Reynolds MR et al, J Am Coll Cardiol 2016;67:29-38)... (excerpt)