There were no differences within 31 to 365 days after the surgery date and within the 30 days post-discharge. Risk of operative mortality was 19% higher for mechanical valves than for bioprosthetic valves (OR, 1.21; 95% CI, 1.13-1.30; P< 0.0001). The number needed to treat with mechanical valves to observe one additional death on the surgery date was 290. Consistent findings were observed in subgroup analyses of patients who underwent concurrent AVR and Coronary Artery Bypass Graft (CABG), but not in isolated AVR subgroup. ConClusions: In this cohort analysis of Medicare beneficiaries, mechanical aortic valves were associated with a higher risk of death on the surgery date and within the 30 days following surgery when compared with bioprosthetic aortic valves among patients who underwent concurrent AVR and CABG, but not isolated AVR.
A45Objectives: Patients undergoing cardiac surgery (CS) routinely receive intravenous (IV) crystalloids perioperatively (during and immediately post-surgery). A study using a large US electronic health record database, reported an association between the use of low-chloride IV crystalloids and improved outcomes. Here we examine the association between perioperative crystalloid choice and treatment costs among adults undergoing CS. MethOds: Patients who underwent CS between January 2009-June 2013 and received ≥ 500 mL of IV crystalloids within 1 day post-surgery, survived ≥ 1 day, and had recorded data on charges were included. Main exclusion criteria were hospital stay > 30 days and receipt of > 1 L IV fluids on the day before surgery. Patients were categorized as receiving either 0.9% saline exclusively as their primary IV fluid, Lactated Ringer's (LR), or a calcium-free balanced crystalloid (Plasma-Lyte (CF-BAL)). Outcomes were compared in three propensity-matched cohorts and included total cost, cost/day/patient, and length-of-stay (LOS). Costs were calculated using published cost-to-charge ratios. Results: In the propensitymatched cohorts (CF-BAL versus saline (n= 298 patients); CF-BAL versus LR (n= 516); LR versus saline (n= 2,930)), CF-BAL was associated with significantly lower total costs than either saline
shown that the coating impairs bioavailability and results in slower and less predictable antiplatelet activity compared with regular aspirin. The lack of definitive clinical trials demonstrating that the use of enteric-coated aspirin delivers the same efficacy as regular aspirin supplements the uncertainty. In fact, multiple recently published trials with enteric-coated aspirin failed to show benefit while showing increased GI bleeding. It therefore seems that adding a delayed-release coating to aspirin failed to deliver a safer next generation agent and may have jeopardized the ability to block platelets and prevent CV events. As such, a great unmet need remains for an alternative formulation with a safer GI profile and uncompromised antiplatelet activity.
ConClusions: The number and percentage of ultra-orphan drugs approved by the FDA increased in comparison with orphan drugs for rare diseases with a larger number of patients in the period 1983-2014.
A137 with maternal hypertension. Early diagnosis and treatment through regular antenatal check-up is a key factor to prevent PIH and its complications. Interventions to improve maternal health through information, education and counselling of women of child bearing age should be implemented.Objectives: Increased perioperative blood pressure (BP) variability in cardiac surgery is associated with negative clinical outcomes and increased health resource utilization (HRU). Clevidipine, an ultrashort-acting, arterial selective calcium channel blocker reduces BP variability and may reduce HRU in this setting. The current model evaluates the one year budget impact of adding clevidipine to an intravenous antihypertensive (IVAH) treatment mix in a sample US hospital. MethOds: A spreadsheet model was developed using treatment specific HRU data from a clevidipine clinical trial (ECLIPSE) in cardiac surgery. Treatment distribution for IVAH agents (clevidipine, nicardipine, nitroglycerin, and nitroprusside), case volumes and comparable IVAH dosages were obtained from the Premier Hospital database. Unit costs for IVAH are US Wholesale Acquisition Costs (WAC). Thirtyday event costs were from the published literature. The model inputs may be customized to more accurately represent a given healthcare system. Results: The base case assumed a sample hospital with 468 coronary artery bypass graft (CABG) cases and 322 heart valve (HV) cases annually. Clevidipine usage in the base case was minimal (0% in CABG; 1% in HV). The base case predicts a one year total cost of $19,045,453 with the largest proportion of costs from general ward, ICU and operative suite time (approx. 30%, 21%, and 20% respectively). One year IVAH costs totaled $93,958 or 0.5% of total costs. Increasing the proportion of cases receiving clevidipine to 5% for both procedures increased drug acquisition costs by $13,005 and decreased HRU-related costs by $48,439 for a net decrease in costs of $35,434 for one year. cOnclusiOns: This analysis predicts a net savings with an increase in clevidipine use. In this example case, a minimal increase in IVAH costs was offset by savings in HRU-related costs resulting from improved outcomes associated with reduced perioperative BP variability.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.