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Lu J, Zhang L, Lu Y, Su M, Li X, Li J, Liu J, Zhang H, Nasir K, Masoudi F, Krumholz H, Zheng X. P834Secondary prevention medications of cardiovascular diseases in China: findings from China PEACE million persons project. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiovascular diseases (CVD) is the leading cause of death in China. Secondary prevention medications can improve the prognosis of CVD, yet little is known about the current use, variation and associated factors of these therapies in China.
Purpose
The aim of this study was to describe the current use of secondary prevention medications among patients with established CVD in the community setting in China, assess variations across population subgroups, and identify the individual characteristics associated with these therapies.
Methods
We studied 2.6 million participants aged 35–75 years from all 31 provinces in the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project, a government-funded public health program conducted from 2014 to 2018. Participants self-reported their history of ischemic heart disease (IHD) or ischemic stroke (IS) and medication use in an interview. Among participants with IHD and/or IS, we assessed the reported use of secondary prevention medications (anti-platelet drugs and statins) in the overall population and in 1,530,408 population subgroups, defined by all possible combinations of 16 factors (age, sex, urbanity, geographic region, ethnicity, occupation, annual household income, education, marital status, medical insurance, current smoker, current drinker, history of hypertension, history of diabetes, body mass index and years since diagnosis). Multivariable mixed models with a logit link function and community-specific random intercepts were fitted to assess the associations of demographic, socioeconomic and health behavior factors with the reported use of secondary prevention mediations.
Results
Among 2,613,035 screened participants, 2.9% (74,830) had history of IHD and/or IS (1.2% for IHD, 2.4% for IS). Overall, the reported use rate either anti-platelet drugs or statins was 21.9% (18.3% anti-platelet drugs, 11.0% statins, and 7.4% both). Among the 1,530,408 population subgroups, the use of secondary prevention medications varied substantially (3.4% to 52.0%). Multivariable analyses found that that younger people, women, those living in rural areas, current smokers, current drinkers, people without hypertension or diabetes, and those with established CVD for more than 2 years were less likely to take anti-platelet drugs or statins (Figure).
Forest plot of multivariable mixed model
Conclusions
The current use of secondary prevention drugs is suboptimal and varies substantially across population subgroups in China. Our study identifies target populations for interventions to improve secondary prevention of CVD.
Acknowledgement/Funding
This study was supported by the Ministry of Finance of China and National Health Commission of China
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Affiliation(s)
- J Lu
- Fuwai Hospital- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - L Zhang
- Fuwai Hospital- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Y Lu
- Yale University, Center for Outcomes Research and Evaluation, New Haven, United States of America
| | - M Su
- Fuwai Hospital- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - X Li
- Fuwai Hospital- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - J Li
- Fuwai Hospital- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - J Liu
- Fuwai Hospital- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - H Zhang
- Fuwai Hospital- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - K Nasir
- Yale University, Center for Outcomes Research and Evaluation, New Haven, United States of America
| | - F Masoudi
- University of Colorado Anschutz Medical Campus, Division of Cardiology, Aurora, United States of America
| | - H Krumholz
- Yale University, Center for Outcomes Research and Evaluation, New Haven, United States of America
| | - X Zheng
- Fuwai Hospital- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Venkatesh A, Mei H, Kocher K, Spatz E, Granovsky M, Eichenfeld J, Krumholz H, Lin Z. 143 Improving the Identification of Emergency Department Visits in Medicare Administrative Claims. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2016.08.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Decker C, Garavalia L, Abramsohn E, Garavalia B, Krumholz H, Spertus J, Lindau S. P133 Poster Is sex on a woman's mind after an MI. Eur J Cardiovasc Nurs 2011. [DOI: 10.1016/s1474-51511160080-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- C. Decker
- Mid America Heart Institute, Kansas City, United States of America
| | - L. Garavalia
- University of Missouri-Kansas City, School of Pharmacy, Kansas City, United States of America
| | - E. Abramsohn
- University of Chicago Hospitals, Chicago, United States of America
| | - B. Garavalia
- Mid America Heart Institute, Kansas City, United States of America
| | - H. Krumholz
- Yale University, New Haven, United States of America
| | - J. Spertus
- Mid America Heart Institute, Kansas City, United States of America
| | - S. Lindau
- University of Chicago Hospitals, Chicago, United States of America
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Graff L, Wang Y, Foody J, Meehan T, Tuozzo K, Krumholz H, Radford M. Delay in diagnosis of acute myocardial infarction: Increasingly common, lower quality of care. Ann Emerg Med 2004. [DOI: 10.1016/j.annemergmed.2004.07.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Weintraub WS, Culler SD, Kosinski A, Becker ER, Mahoney E, Burnette J, Spertus JA, Feeny D, Cohen DJ, Krumholz H, Ellis SG, Demopoulos L, Robertson D, Boccuzzi SJ, Barr E, Cannon CP. Economics, health-related quality of life, and cost-effectiveness methods for the TACTICS (Treat Angina With Aggrastat [tirofiban]] and Determine Cost of Therapy with Invasive or Conservative Strategy)-TIMI 18 trial. Am J Cardiol 1999; 83:317-22. [PMID: 10072215 DOI: 10.1016/s0002-9149(98)00860-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Concern over escalating health care costs has led to increasing focus on economics and assessment of outcome measures for expensive forms of therapy. This is being investigated in the Treat Angina With Aggrastat [tirofiban] and Determine Cost of Therapy with Invasive or Conservative Strategy (TACTICS)-TIMI 18 trial, a randomized trial comparing outcome of patients with unstable angina or non-Q-wave myocardial infarction treated with tirofiban and then randomized to an invasive versus a conservative strategy. Hospital and professional costs initially and over 6 months, including outpatient costs, will be assessed. Hospital costs will be determined for patients in the United States from the UB92 formulation of the hospital bill, with costs derived from charges using departmental cost to charge ratios. Professional costs will be determined by accounting for professional services and then converted to resource units using the Resource Based Relative Value Scale and then to costs using the Medicare conversion factor. Follow-up resource consumption, including medications, testing and office visits, will be carefully measured with a Patient Economic Form, and converted to costs from the Medicare fee schedule. Health-related quality of life will be assessed with a specific instrument, the Seattle Angina Questionnaire, and a general instrument, the Health Utilities Index at baseline, 1, and 6 months. The Health Utilities Index will also be used to construct a utility. By knowing utility and survival, quality-adjusted life years will be determined. These measures will permit the performance of a cost-effectiveness analysis, with the cost-effectiveness of the invasive strategy defined and the difference in cost between the invasive and conservative strategies divided by the difference in quality-adjusted life years. The economic and health-related quality of life aspects of TACTICS-TIMI 18 are an integral part of the study design and will provide a comprehensive understanding of the impact of invasive versus conservative management strategies on a broad range of outcomes after hospitalization for unstable angina or non-Q-wave myocardial infarction.
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Affiliation(s)
- W S Weintraub
- Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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Fontes ML, Lin ZQ, Matthew JP, Mattera J, Krumholz H, Shaw R, Passik C, Hashim S, Dewar M, Kopf G, Elefeteriades J, Barash PG. IS THE COST OF CARDIAC SURGERY INFLUENCED BY GENDER? Anesthesiology 1998. [DOI: 10.1097/00000542-199809060-00061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ghobashy A, Mathew J, Fontes M, Garwood S, McCloskey G, Davis E, Barash P, Krumholz H. ACOUSTIC QUANTIFICATION AND COLOR KINESIS. Anesth Analg 1998. [DOI: 10.1213/00000539-199804001-00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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