Implantable Defibrillators Prove Moderately Cost Effective
Implantable defibrillators save lives and are somewhat more cost-effective than intensive treatment with antiarrhythmic drugs. The real cost saving, though, comes from reduced hospital stays, according to investigators in the Antiarrhythmic Versus Implantable Defibrillators (AVID) trial. In their analysis, Greg Larsen, MD, of the Portland (Oregon) Veterans Affairs Medical Center, and his AVID colleagues demonstrated a moderate cost-benefit favoring the use of implantable defibrillators as a secondary preventive method against life-threatening arrhythmias.
In the study, detailed in this week’s issue of Circulation (Circulation. 2002;105:2049–2057), the physicians analyzed initial and repeat hospitalizations, including emergency room and day surgery stays, as well as the cost of antiarrhythmic drugs on 1008 patients. They also evaluated medical encounters and expenses collected on a subgroup of 237 patients and used statistical modeling to apply these charges to the other patients.
At 3 years, the authors wrote, the total costs were $71 421 for a patient who takes antiarrhythmic drugs and $85 522 for a patient on an implantable defibrillator. The defibrillator provided a 0.21-year survival benefit over the treatment with antiarrhythmic drugs. Under the model the investigators used for their analysis, the base case cost-effectiveness ratio was $66 677 per year of life saved by the implanted defibrillator, compared with patients on antiarrhythmic drugs. The cost-effectiveness ratio was $68 000 per year of life saved for 6 years, and $80 000 for 20 years.
The Role of C-Reactive Protein in Heart Disease Strengthens
Levels of serum C-reactive protein were increased in patients with sudden death, particularly those with acute rupture of atheromas, according to a study published by researchers from the Armed Forces Institute of Pathology in Washington, DC, the University of Vermont in Burlington, Louisiana State University Health Science Center in New Orleans, and the University of Maryland in Baltimore. The study, led by Allen P. Burke, MD, of the Division of Cardiovascular Pathology at the Armed Forces Institute of Pathology, is among the first to attempt to link levels of C-reactive protein to various fatal pathologies.
The study, published in this week’s issue of Circulation (Circulation. 2002;105:2019–2023), showed that there is a small elevation of C-reactive protein levels in the blood of patients who died of sudden coronary death, regardless of the cause of that fatal condition. However, the levels were higher in patients who died of acute coronary thrombi associated with plaque rupture or erosion. Higher levels were also seen in patients who died with stable plaque without evidence of clotting.
Marked elevations of the C-reactive protein were also seen in patients with inflammatory conditions and dying heart muscle. The authors noted that the study found a high correlation between increased levels of C-reactive protein in the blood and increased numbers of unstable plaque in the network of coronary arteries.
“The results of the current study suggest that high-sensitivity C-reactive protein (hsCRP) is a marker for coronary atherosclerosis, especially those lesions rich in lipid core and macrophages. Elevated serum levels of hsCRP were greatest in hearts harboring acute rupture and erosion. However, we were unable to demonstrate any significant increase or spike in serum hsCRP with lethal acute coronary thrombosis as compared to patients dying with stable plaque. It is unclear whether the lack of significance is due to the relatively small sample size or whether inflammatory mechanisms represent only a portion of the risk for developing fatal thrombosis,” they concluded.
“Despite a relatively small number of cases, we observed a significant association of hsCRP with risk of dying from stable plaque, strengthening the role of hsCRP as a major risk factor for the development of clinical manifestations of coronary artery disease.”
Angry Young Men Less Likely to Become Old Men
Know a young man who becomes angry rather than contemplative? He faces three times the normal risk of developing premature heart disease, according to researchers from Johns Hopkins University School of Medicine, in a study published in the April 22, 2002 issue of the Archives of Internal Medicine (Arch Intern Med. 2002;162:901–906). Young men who participate in gripe sessions or become irritable more easily were 5 times more likely to have an early heart attack, even without a family history of heart disease, the researchers reported.
“In this study, hot tempers predicted disease long before other traditional risk factors like diabetes and hypertension became apparent,” said Patricia P. Chang, MD, the study’s lead author and a cardiology fellow. “The most important thing angry young men can do is get professional help to manage their tempers, especially since previous studies have shown that those who already had heart disease got better with anger management.”